New approach for treating benign paroxysmal positional vertigo (BPPV) in primary care settings - A pilot study

Abstract

Objective: To evaluate the efficacy of a tentative treatment protocol designed for treating benign paroxysmal positional vertigo (BPPV) in primary care settings. Design: Single arm prospective trial. Subjects: The new treatment protocol involves the use of 4 questions to screen for probable cases of BPPV, performs Dix-Hallpike test only to the symptomatic side and incorporates it into the Epley manoeuvre, disregards the nystagmus pattern, performs up to 3 cycles of Epley manoeuvre in one treatment session, and refers all failure cases to ENT specialists. All doctors in a General Outpatient Clinic (GOPC) were invited to identify probable cases of BPPV with the 4 screening questions, and refer to the main author for management. Phone follow-up was performed at 1 week and 4 weeks after treatment. Main outcome measures: Patients' self report of disappearance of positional vertigo at 1 day, 1 week and 4 weeks after treatment. Results: 14 patients with "objective" BPPV and 4 patients with "subjective" BPPV (no nystagmus on positional testing) were identified. In the objective BPPV group, 11 patients completely recovered and 1 patient partially improved in the first week after treatment, giving an overall success rate of 85.7%. There were too few patients in the subjective BPPV group for analysis. Conclusion: The new treatment protocol appears to be highly effective for treating patients with objective BPPV although this is only a small pilot study. Further trial with larger number of patients is required.