Canalith Repositioning and Semont Liberatory Maneuvers have been shown to be highly efficacious in the successful treatment of Benign Paroxysmal Positional Vertigo (BPPV). The differentiation of canalalithiasis, cupulolithiasis, and correct identification of canal involvement, particularly through the use of Video-oculography, have enhanced treatment decisions and outcomes.Since 1994, approximately 700 BPPV patients have been treated at the authors' clinical facility. An anecdotal study of 376 of these patients followed over a 7-year period is presented. The patients in the historical study all presented with BPPV-PC and were treated with modified Canalith Repositioning Maneuver and Semont Liberatory Maneuver treatment procedures. The review indicated no significant differences in treatment outcomes between the two procedures. Seventy-nine percent of the patients required only one treatment, while 17% required two treatments, 3.5% required three treatments, and 0.05% required four treatments. The average number of treatments was 1.3. The SLM did show a reduced recurrence rate compared to the CRP method.Learning Outcomes: As a result of this activity, the reader will: (1) have a historical perspective of the development of the diagnosis and treatment of BPPV; (2) have a review of the literature of BPPV treatment methodologies; and (3) be able to determine and perform appropriate BPPV treatment methods.Downloaded by: Rutgers University. Copyrighted material.

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo, resulting from migration of otoconia into the semicircular canals. Several treatment methods involving positioning maneuvers that return the otoconia to the utricle have been described. Following treatment, most patients are provided with a variety of activity restrictions. Previous studies suggest that, overall, BPPV treatment may be successful without these restrictions. The purpose of this study was to determine the necessity of postmaneuver restrictions using an experimental and control group with participants matched for age, gender, involved ear, and symptoms. A canalith repositioning maneuver was used to treat the BPPV. During postmaneuver instruction, the 21 participants assigned to the restricted group were provided with typical activity restrictions. Twenty-one participants assigned to the nonrestricted group were given no postmaneuver restrictions. Only one participant in the restricted group and two participants in the nonrestricted group were not clear at the one-week follow-up appointment. Results indicated that postmaneuver restrictions do not improve treatment efficacy.

The results suggest that the volitional head movement paradigm may be useful in identification of patients with functional deficits of the vestibulo-ocular reflex.

Utilities as measured through the UMAA seem sensitive to changes in HRQoL after treatment of BPPV. Since the UMAA can be used to measure patient preference (i.e., utility), it may be useful for comparison of specific audiologic conditions, such as BPPV, to nonaudiologic conditions, such as cardiovascular disease and kidney disease.

This article presents an approach to differentiation of migrainous positional vertigo (MPV) from horizontal canal benign paroxysmal positional vertigo (HC-BPPV). Such an approach is essential because of the difference in intervention between the two disorders in question. Results from evaluation of the case study presented here revealed a persistent ageotropic positional nystagmus consistent with MPV or a cupulolithiasis variant of HC-BPPV. The patient was treated with liberatory maneuvers to remove possible otoconial debris from the horizontal canal in an attempt, in turn, to provide further diagnostic information. There was no change in symptoms following treatment for HC-BPPV. This case was diagnosed subsequently as MPV, and the patient was referred for medical intervention. Treatment has been successful for 22 months. Incorporation of HC-BPPV treatment, therefore, may provide useful information in the differential diagnosis of MPV and the cupulolithiasis variant of HC-BPPV.