Last week’s post described an experiment we did that showed us that home exercises for suspected BPPV were very effective. What, then, is the benefit of undergoing in-office Canalith Repositioning (CRP) treatment?
Before we begin, I think it’s important to discuss the natural course of BPPV. It is a self-limiting condition, meaning that over time it doesn’t get worse, but rather gets better (on average after several weeks). If you are willing to wait long enough, it will eventually resolve on its own (although you are susceptible to recurrences). In the meantime, it is pretty miserable and treatments are available that are fast, effective, and safe.
Any studies regarding the effectiveness of treatments for BPPV should not consider symptom resolution after a few weeks, because the treatment may not have been the cause of the resolution. Time may have been the key to resolution. Ideally, any studies should look at changes in symptoms after 48 hours, or at most one week following treatment.
The first and most important benefit to in-office CRP versus home exercises is that they resolve the symptoms more quickly. A 2012 study from Spain showed that CRP resulted in a negative Dix-Hallpike exam at seven-day follow up in 85% of patients, while Brandt-Daroff exercises performed at home had the same result in only 25% of patients.
Achieving 85% symptom resolution from CRP is consistent with other studies, but only 25% achieving resolution after a week of home exercises is very low and quite inconsistent with our findings cited in last week’s blog. This makes me wonder. Were the patients doing the exercises correctly? Is there such a big difference between the Brandt Daroff exercises and the home exercise version of the modified Epley maneuver? Let’s tackle that one next week.