Which treatment is most effective?
Last week, I finished my blog post with a question regarding the relative effectiveness of different home exercises for BPPV. This question has been pondered by others for several years. As early as 1999 (roughly eight years before the iPhone was introduced and while Bill Clinton was the president), Radtke and colleagues compared the relative effectiveness of a home version of a Modified Epley Procedure (MEP) with Brandt Daroff (BDE) exercises. They reported that “after one week, 18 of 28 (64%) using the MEP were asymptomatic compared with 6 of 26 patients (23%) using the BDE.” While these data indicate that the MEP may be more effective than the BDE, neither is nearly as effective as in-office Canalith Repositioning, as described in last week’s post.
A few years later, the same group (mostly) compared the effectiveness of the same home version of the MEP to a home version of the Semont Manuever (SM). They reported that the MEP resolved complaints of positional vertigo in 95% of patients after one week; however, the same success was achieved in only 58% of the MSM group, primarily as a result of incorrect performance or the MSM. So, is even a poorly performed SM more effective than Brandt Daroff exercises?
More recently, a group out of China published a study that compared all three techniques frequently used for home treatment of BPPV. Not surprisingly, the authors found the MEP to be most effective, and the BDE least effective. What I found particularly interesting was that they found the BDE to be no more effective than no treatment at all. Yet, I still see at least one patient a week who has been given BDE for suspected BPPV.
Photo courtesy of https://www.med.unc.edu/ent/adunka/for-patients/symptoms-disorders/benign-paroxysmal-positional-vertigo-bppv
