Benign paroxysmal positional vertigo: A review of the particle repositioning manoeuvres

Benign paroxysmal positional vertigo is the most common cause of peripheral vertigo. Different treatments are used to alleviate the symptoms of vertigo and nystagmus. These are based on an attempt to reposition the particles in the semi-circular canals that is believed to be the cause of this pathology. In this review we compare the different manoeuvres used depending on the type of BPPV in an attempt to identify which therapy is more effective in symptomatic resolution. Epley and Semont manoeuvres have been found to be effective in symptom resolution of posterior BPPV with high repositioning success rates. Attempted comparisons between the 2 manoeuvres showed a tendency towards superiority of Epley manoeuvre but this is not supported by large RCTs. Similarly, the barbeque roll and Gufoni manoeuvres found to have increase effectiveness in treated horizontal BPPV but there is not enough evidence to suggest that the one manoeuvre is superior to the other. The ‘reverse Epley’ or ‘reverse Semont’ manoeuvre are proposed for treatment of superior BPPV but there is lack of good evidence to verify their effectiveness.