Document Detail


Particle Repositioning Maneuver Versus Brandt-Daroff Exercise for Treatment of Unilateral Idiopathic BPPV of the Posterior Semicircular Canal: A Randomized Prospective Clinical Trial With Short- and Long-Term Outcome.
MedLine Citation:
PMID:  22935812     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: To compare the outcome and probability of recurrence in a series of patients with unilateral idiopathic benign paroxysmal positional vertigo of the posterior canal (PC-BPPV) that were randomly treated by Brandt-Daroff exercise (B-D exercise) or by particle repositioning maneuver (PRM). STUDY DESIGN: Randomized prospective clinical trial. SETTING: Tertiary referral center. PATIENTS: Patients were included in this study if they complained of vertigo and had been diagnosed as having unilateral idiopathic PC-BPPV for at least 1 week before Dix-Hallpike maneuver (DHM), remained for 30 days in the randomly assigned treatment, and had at least 48 months' follow-up. INTERVENTION: Forty-one patients were treated with a single PRM and 40 patients by B-D exercise. MAIN OUTCOME MEASURE: Resolution of benign paroxysmal positional nystagmus on the DHM. The probability of recurrence was also studied. RESULTS: At Day 7, DHM was negative in 80.5% of the PRM-treated patients and in 25% of those treated by B-D exercise (p < 0.001). At Month 1, the differences between both treatment groups remained statistically significant (92.7% in PRM versus 42.5% in the B-D exercise had a negative DHM; p < 0.001). The variable that influenced that DHM became negative was the PRM (RR = 4.8; 95% confidence interval, 2.5-9.2; p < 0.001). The number of recurrences in PRM and B-D exercise were 0.56 ± 0.8 and 0.48 ± 0.8, respectively (p = 0.48). The recurrence rate at 48 months was 35.5% (15/41) in B-D exercise and 36.6% (9/31) in the PRM group (p = 0.62). Although the time interval until the first recurrence was similar (p = 0.44), patients included in the PRM group showed a significantly longer time interval between the first and second recurrence (p = 0.04). CONCLUSION: PRM is more effective treatment and as safe as B-D exercise in the short term for unilateral and idiopathic PC-BPPV, and although it does not reduce the probability of recurrence in the 4-year follow-up period compared with B-D exercise, it may delay the second recurrence's onset in those patients who had already experienced a single recurrence. Our study supports the use of PRM as the treatment of choice in unilateral and idiopathic PC-BPPV, although exercise may be also considered as an alternative treatment in selected cases.
Authors:
Juan Carlos Amor-Dorado; Maria Pilar Barreira-Fernández; Ismael Aran-Gonzalez; Emilio Casariego-Vales; Javier Llorca; Miguel Angel González-Gay
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-29
Journal Detail:
Title:  Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology     Volume:  -     ISSN:  1537-4505     ISO Abbreviation:  Otol. Neurotol.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-31     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100961504     Medline TA:  Otol Neurotol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
*Otolaryngology Division, University Hospital Lucus Augusti; †Division of Otolaryngology, Complexo Hospitalario de Pontevedra; ‡Division of Internal Medicine and Master in Statistical, University Hospital Lucus Augusti, Lugo; §Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBER Epidemiología y Salud Pública (CIBERESP), IFIMAV; and ∥Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IFIMAV, Santander, Spain.
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