Single treatment approaches to benign paroxysmal positional vertigo.

OBJECTIVE To determine the effectiveness of two different physical therapy approaches for benign paroxysmal positional vertigo. DESIGN Randomized study. SETTING Outpatient clinic. PATIENTS Consecutive sample of 60 patients with benign paroxysmal positional vertigo. INTERVENTION Patients received either a single treatment based on the hypothesis that the vertigo and nystagmus of benign paroxysmal positional vertigo are due to debris adhering to the cupula of the posterior semicircular canal (cupulolithiasis) or a single treatment based on the hypothesis that the debris is free floating in the long arm of the posterior canal (canalithiasis). Patients were reevaluated 1 to 2 weeks after the treatment and again 4 to 6 months later. OUTCOME Treatment outcome was classified as either asymptomatic, more than 70% improved as rated by the patient, or no change. RESULTS The treatment designed for cupulolithaisis resulted in remission of vertigo and nystagmus in 70% of the patients and in improvement of the symptoms in another 20%. The treatment designed for canalithiasis resulted in remission of vertigo and nystagmus in 57% of the patients and in improvement in another 33%. There was no statistically significant difference between treatments. CONCLUSIONS These single-treatment approaches are equally effective treatments for benign paroxysmal positional vertigo. Further studies are needed to look at the long-term effectiveness of these treatments.