What are the treatment options for benign paroxysmal positioning vertigo (BPPV)?

Updated: Mar 13, 2017
  • Author: Hesham M Samy, MD, PhD; Chief Editor: Robert A Egan, MD  more...
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Answer

The American Academy of Neurology has published a practice parameter for the treatment of BPPV. [12] The most effective treatment is canalith repositioning from the affected canal back to the vestibule where it is absorbed using the most common maneuvers: Epley, Semont, Lempert, and Hamid (for horizontal canal cupulolithiasis). Medications can be helpful for short-term reduction of symptoms but have not been shown to be effective in the long-term treatment of BPPV.

It is important to note that most cases of BPPV can be treated in the office once the history and examination confirm the diagnosis. Prolonged sessions of physical therapy are not necessary and not cost effective. Some of these patients may also require medications, which should be given under physician supervision, to treat severe nausea and vomiting that can result from CRP treatments.

The most common complication of the Semont or Epley maneuver is conversion of the posterior canal−horizontal canal BPPV, which is treated with the Lempert or Hamid maneuvers. A less common complication is undue cervical strain, which is especially likely with the Semont maneuver or with neck hyperextension during the Epley maneuver.


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