The Role of Postural Restrictions after BPPV Treatment: Real Effect on Successful Treatment and BPPV’s Recurrence Rates

Abstract

<jats:p><jats:italic>Background</jats:italic>. Canalith repositioning techniques are adequately established in the literature, as the treatment of choice for benign paroxysmal positional vertigo. However, the role of the posttreatment instructions is still not clearly defined.<jats:italic>Patients and Methods</jats:italic>. A retrospective chart review of 82 patients was conducted in order to determine the efficacy of postural restrictions, when combined with the classic canalith repositioning techniques, in terms of successful treatment and recurrence rates. Follow-up period reached at least 12 months after the initial treatment.<jats:italic>Results</jats:italic>. In this study, postural restrictions did not appear to significantly affect the outcomes of repositioning maneuvers, as well as the recurrence rate.<jats:italic>Conclusions</jats:italic>. Although this study, as well as most recent control studies, states that there is no significant effect of postmaneuver postural restrictions on both treatment and recurrence rates, larger multicentric research projects, adopting improved methodology, are still necessary in order to determine the contribution of such restrictions to both the therapeutic results and the prevention of recurrence. Adequate followup, focusing on the first six months after the initially successful repositioning maneuver, is also of paramount importance.</jats:p>

Effect of a Hybrid Maneuver in Treating Posterior Canal Benign Paroxysmal Positional Vertigo

“…The results of our study are not surprising, as they are more or less in accordance with the current literature. Our findings agree with most of the previous studies (DeBoodt, 2003;Radtke et al, 2004;Roberts et al, 2005;Fyrmpas et al, 2009;De Stefano et al, 2011;Papacharalampous et al, 2012;Toupet et al, 2012) that investigated the efficacy of postural restrictions on the success rate of CRM and reported that these restrictions do not influence resolution of BPPV. In addition, most of the patients in the restricted groups expressed a serious sense of discomfort.…”

“…In addition, there are contradictory reviews on the need for involvement of postmaneuver restrictions as a part of the treatment protocol for BPPV (Fyrmpas et al, 2009;De Stefano et al, 2011;Papacharalampous et al, 2012), which are used in an effort to prevent the otoconial debris from returning to the semicircular canals after treatment. Cakır et al (2006) and McGinnis et al (2009) stated positive outcomes for these restrictions.…”

The long-term follow-up of 61 horizontal canal BPPV after Gufoni and Barbecue maneuver: a prospective study

“…All the patients in our study are instructed with the postural restriction (avoid sudden head movements and lying on their affected side) in at least three days after the CRM, in order to prevent canalith from going back to the affected canal. There are some reports that show postural restrictions appeared significant as a post-treatment instruction [15], while some others show it did not affect the outcomes of CRM, as well as the recurrence rate [16]. There are also some reports about canal conversions after reposition.…”

Impact of Postmaneuver Sleep Position on Recurrence of Benign Paroxysmal Positional Vertigo

“…The patients sleeping on their affected side after the repositioning maneuver had a higher recurrence rate than patients with other sleep positions. However, other studies did not find an effect of postural restrictions on recurrence of BPPV [14]–[16], [18], [22]. Another study showed that the time course in remission of positional vertigo is not affected by the head-lying side during sleep [31].…”