![]() ![]() His conclusions are that these maneuvers efficacies are not yet satisfactorily determined. Van der Velde 15 analyzed other conservative and non-pharmacological physical treatments besides repositioning maneuvers. Some papers have shown little effect of canal repositioning maneuvers as to long lasting symptoms improvement, as well as weak evidence when compared to other therapeutic resources (physical therapy, medical or surgery related) for posterior semicircular canal BPPV, especially due to a lack of good quality clinical studies 6,14. Habituation exercises are used for milder residual complaints 2. We typically use canal repositioning treatment or releasing maneuvers. Efficacy studies state that all three facilitate recovery. There are three basic BPPV treatments, each with its own use indication: canal repositioning, releasing exercises and habituation exercises. Head position exercises attempt to reach central nervous system adaptation and compensation mechanisms, trying symptom recovery. The main goal of these maneuvers is to take the free debris from the semicircular canal back to the utricle, where they presumable adhere1. ![]() This therapy involves head position changes in a series of repetitions, as proposed by Brandt and Daroff 8, Semont´s releasing maneuver, Epley's canalicular repositioning 1,9, among others 10-13. As we repeat the maneuver, fatigue ensues, reducing nystagmus intensity until it totally recedes in the third or fourth repetition.īPPV clinical findings agree with the hypothesis that semicircular canals, with greater incidence on the posterior canal, have floating particles or debris, which are heavier than the circulating endolymph 5.Īlthough the exact mechanism by which these debris cause BPPV and nystagmus is still unknown 1, it is broadly accepted that a canal lithiasis phenomenon be responsible for this condition 6.Įach free debris point require a different treatment strategy, through maneuvers comprised of head movements, in order to restore normal semicircular canal function and thus eliminate vertigo and positional nystagmus 7. Rotational nystagmus is typical: four to five second latency and duration of 30 to 40 seconds. We have a positive maneuver when it triggers vertigo and nystagmus when the patient changes posture from sitting to laying down with his/her head hanging downwards horizontally, with a 45° head turn towards the tested side 3,5,6. However, some patients experience recurrent symptoms months or even years later, which may vary from short spells to decades of suffering, with short remission spans 5.ĭix-Hallpike maneuver aids in diagnosis. Symptoms tend to spontaneously resolve after a few weeks or months. ![]() ![]() Because of its clinical characteristics, patients feel fearsome, and both vertigo as well as triggering head movements might considerably limit their daily activities 5. The interview reveals a typical history with short vertigo spells at head movements 4. It is clinically characterized by recurrent vertigo spells, usually triggered by certain head movements or patient's change in posture 3.ĭiagnosis is clinical. There is scientific evidence showing good efficacy of Epley's maneuver in the treatment.īenign paroxysmal positional vertigo (BPPV) is one of the most frequent vestibular disorders 1,2. There are no studies about the efficacy of Semont's maneuver. The metaanalysis showed positive evidence of Epley's maneuver to the posterior semicircular canal (effect size = 0.11 of objective improvement within one week, 0.24 within one month and 0.16 of improvement reported by the patients within one week. We found five controlled clinical trials phase I comparing the Epley's maneuver with controls or placebo. The trials were assessed using Jadad's scale and only studies with quality scores equal or above 3 were pooled on a meta-analyses to assess their effectiveness. The main outcome was Dix-Hallpike negative test and the changes to subjective complaints. The trials should have included physical maneuvers such as Epley and Semont. MethodologyĪn electronic search at the main databases, including MEDLINE, LILACS, PEDro, Cochrane Collaborations Database was performed, and we selected only randomized clinical trials studying adults with diagnosis of BPPV confirmed by the Dix-Hallpike test. To asses the effectiveness of the specific maneuvers available to the treatment of BPPV. There are several approaches for treatment, but efficacy is still being discussed. Benign Paroxysmal Positional Vertigo (BPPV) is one of the most frequent diseases of the vestibular system and it is characterized by episodes of recurrent vertigo triggered by head movements or position changes. ![]()
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