Clinical characteristics of patients with multi-canal benign paroxysmal positional vertigo

IntroductionMulti-canal benign paroxysmal positional vertigo is considered to be a rare and controversial type in the new diagnostic guidelines of Bárány because the nystagmus is more complicated or atypical, which is worthy of further study.ObjectiveBased on the diagnostic criteria for multi-canal benign paroxysmal positional vertigo proposed by International Bárány Society, the study aimed to investigate the clinical characteristics, diagnosis and treatment of multi-canal benign paroxysmal positional vertigo.MethodsA total of 41 patients with multi-canal benign paroxysmal positional vertigo were included and diagnosed by Roll, Dix-Hallpike and straight head hanging tests. Manual reduction was performed according to the involvement of semicircular canals.ResultsAmong the 41 cases, 19 (46.3%) patients showed vertical up-beating nystagmus with or without torsional component and geotropic, apogeotropic horizontal nystagmus, and were diagnosed with posterior-horizontal canal. 11 (26.8%) patients showed vertical up-beating nystagmus with torsional component on one side and vertical down-beating nystagmus with or without torsional component on the other side during Dix-Hallpike test or straight head hanging test and were diagnosed with posterior-anterior canal benign paroxysmal positional vertigo 9 (26.8%) patients showed vertical down-beating nystagmus with or without torsional component and geotropic, apogeotropic horizontal nystagmus, and were diagnosed with anterior-horizontal canal 2 (4.9%) patients showed vertical geotropic torsional up-beating nystagmus on both sides and were diagnosed with bilateral posterior canal benign paroxysmal positional vertigo. High correlation between the sides with reduced vestibular function or hearing loss and the side affected by Multi-canal benign paroxysmal positional vertigo was revealed (contingency coefficient = 0.602, p = 0.010). During one-week follow up, nystagmus/vertigo has been significantly alleviated or disappeared in 87.8% (36/41) patients.ConclusionPosterior-horizontal canal benign paroxysmal positional vertigo was the most common type. Multi-canal benign paroxysmal positional vertigo involving anterior canal was also not uncommon. Caloric tests and pure tone audiometry may help in the determination of the affected side. Manual reduction was effective in most of Multi-canal benign paroxysmal positional vertigo patients.     

Subjective visual horizontal in patients with posterior canal benign paroxysmal positional vertigo

CONCLUSION: Patients with posterior canal benign paroxysmal positional vertigo (p-BPPV) could have mild excitation in the vestibular system on the affected side. OBJECTIVE: p-BPPV is considered to be caused by small particles dislodged from the utricular macula. While subjective visual horizontal (SVH) mainly reflects utricular function, there is less documentation on SVH in patients with p-BPPV. The purpose of this study was to clarify whether p-BPPV could affect SVH. PATIENTS AND METHODS: Twenty-eight patients with unilateral idiopathic p-BPPV were enrolled. For comparison, 17 patients with vestibular neuritis and 45 patients with cerebello-pontine angle (CPA) tumor were also examined. For measurement of SVH, we used a device that has a red bar of light-emitting diodes (LEDs) in front of the patient. Subjects were asked to rotate the bar to the position that they felt was horizontal in a completely dark room. RESULTS: Deviation of SVH toward the unaffected side down was seen in 82.1% (23/28) of patients with p-BPPV. Mean+/-SD deviation of SVH from the true horizontal to the unaffected side down was 0.49+/-1.21 degrees. Conversely, deviation of SVH was toward the affected side down in 88.2% of patients with vestibular neuritis and in 75.6% of patients with CPA tumor.     

Subjective benign paroxysmal positional vertigo in patients with osteoporosis or migraine

IntroductionSubjective benign paroxysmal positional vertigo is a form of benign paroxysmal positional vertigo in which during the diagnostic positional maneuvers patients only present vertigo symptoms with no nystagmus.ObjectiveTo study the characteristics of subjects with subjective benign paroxysmal positional vertigo.MethodsProspective multicenter case-control study. All patients presenting with vertigo in the Dix-Hallpike test that presented to the participating hospitals were included. The patients were separated into two groups depending on whether nystagmus was present or not. An Epley Maneuver of the affected side was performed. In the follow-up visit, patients were checked to see if nystagmus and vertigo were present. Both groups of patients were compared to assess the success rate of the Epley maneuver and also to compare the presence of 19 variables.Results259 patients were recruited, of which 64 belonged to the subjective group. Nystagmus was eliminated in 67.2% of the patients with benign paroxysmal positional vertigo. 89.1% of the patients with subjective benign paroxysmal positional vertigo remained unaffected by nystagmus, thus showing a significant difference (p = 0.001). Osteoporosis and migraine were the variables which reached the closest to the significance level. In those patients who were taking vestibular suppressors, the percentage of subjective benign paroxysmal positional vertigo was not significantly higher.ConclusionsSubjective benign paroxysmal positional vertigo should be treated using the Epley maneuver. More studies are needed to establish a relationship between osteoporosis, migraine and subjective benign paroxysmal positional vertigo. The use of vestibular suppressants does not affect the detection of nystagmus.     

Results of subjective visual vertical tests in patients with vertigo/dizziness

ObjectiveWe previously established the head-tilt subjective visual vertical (HT-SVV) test to evaluate head-tilt perception gain (HTPG) in addition to the original head-upright SVV (HU-SVV) test (Wada-Y et al.: Laryngoscope Investig Otolaryngol, 2020). In this study, we aimed to investigate the HU-SVV and HT-SVV abnormality rates among patients with vertigo/dizziness.MethodsBetween July 2014 and December 2020, 357 patients were hospitalized for examining the HU-SVV and HT-SVV at our vertigo/dizziness center. Among these patients, 120 had Meniere's disease (MD), 99 had unilateral vestibular disease (UVD), 76 had benign paroxysmal positional vertigo (BPPV), 14 had vestibular migraine (VM), 13 had orthostatic dysfunction (OD), 12 had bilateral vestibular disease (BVD), 12 had central dizziness (CD), 7 had vestibular schwannoma (VS), and 4 had psychogenic dizziness (PD). We determined the reference values of the absolute HU-SVV (<2.5°) and HTPG (0.80–1.25) for the sitting position and used these for calculating the HU-SVV and HT-SVV abnormality rates in each type of vertigo/dizziness.ResultsAmong the 357 patients, 111 had abnormal HU-SVV results (31.1%), 132 had abnormal HT-SVV results (37.0%), and 185 had abnormal HU-SVV and/or HT-SVV results (51.8%). The modified HT-SVV test in combination with the original HU-SVV test could detect gravity perception disturbance in patients with vertigo/dizziness significantly better than the original test alone (chi-square: p=0.00019). The HU-SVV, HT-SVV, and HU-SVV and/or HT-SVV abnormality rates were significantly higher in patients with peripheral vestibular diseases, i.e., MD, UVD, BPPV, and BVD than in those with other types of vertigo/dizziness, i.e., VM, OD, CD, VS, and PD (chi-square: p=0.010, p=0.020, and p=0.0025, respectively).ConclusionThese findings suggest that the combined HT-SVV and HU-SVV test could be a powerful neuro-otologic examination for detecting pathologies in the vestibular otolithic pathway.     

前庭自旋转试验检测结果分析

目的分析眩晕及平衡功能紊乱病人的前庭自动旋转试验（Vestibular Autorotation Test，VAT）检测结果，探讨VAT的临床应用价值。方法对65例眩晕及平衡功能障碍的患者在完成全面临床检查及耳神经功能检查的基础上行VAT测试。结果（1）单侧外周前庭功能损害10例，主要表现为水平前庭一眼反射（VOR）相位延迟及低增益，4例伴有非对称性异常，可伴有垂直VOR相位延迟及增益异常。（2）双侧外周前庭功能低下5例，非对称性均正常，主要表现为垂直VOR相位延迟及增益异常。（3）良性阵发性位置性眩晕（benign positional paroxysmal veaigo，BPPV）27例，其中有9例合并噪声性听力损失，主要异常表现为垂直VOR相位延迟和水平或垂直VOR高增益，部分可伴有水平VOR相位延迟。（4）可疑中枢性病变7例，多表现为水平VOR高增益和垂直VOR相位延迟。结论VAT能反应眩晕病人垂直VOR异常以及传统前庭功能检测不能显示的高频水平VOR异常，高频旋转试验是对前庭功能检测技术的发展和完善。     

继发性后半规管良性阵发性位置性眩晕的诊治

目的 探讨继发性良性阵发性位置性眩晕(BPPV)的诊断和治疗。方法研究继发性后半规管BPPV的内耳疾病6例病历资料,诊断依据为病史及Dix-Hallpike试验诱导出现的眼震结果。结果 6例内耳疾病(分别为突发性聋3例, 梅尼埃病2例, 前庭神经元炎1例)伴有后半规管良性阵发性位置性眩晕被确诊,通过Dix-Hallpike试验诱发出垂直扭转型眼震。结论 继发性BPPV临床较少见,常为后半规管受累,通过Dix-Hallpike试验和Epley手法复位可以确诊和治愈。     

The test and treatment methods of benign paroxysmal positional vertigo and an addition to the management of vertigo due to the superior vestibular canal (BPPV-SC)

A review of the tests and treatment manoeuvres for benign paroxysmal positional vertigo of the posterior, horizontal and superior vestibular canals is presented. Additionally, a new way to test and treat positional vertigo of the superior vestibular canal is presented. In a prospective study, 57 out of 305 patients' visits are reported. They had residual symptoms and dizziness after the test and the treatment of benign paroxysmal positional vertigo of the horizontal canal (BPPV-HC) and posterior canal (PC). They were tested with a new test and treated with a new manoeuvre for superior canal benign paroxysmal positional vertigo (BPPV-SC). Results for vertigo in 53 patients were good; motion sickness and acrophobia disappeared. Reactive neck tension to BPPV was relieved. Older people were numerous among patients and their quality of life (QOL) improved.     

Residual dizziness after successful treatment of idiopathic benign paroxysmal positional vertigo originates from persistent utricular dysfunction

Objective: We used ocular vestibular evoked myogenic potentials to investigate the relationship between residual dizziness and utricular function following the canalith repositioning procedure for benign paroxysmal positional vertigo.

Methods: Ocular vestibular evoked myogenic potentials were measured in 44 patients (40 included in analyses, four excluded) with successful results from the canalith repositioning procedure. The patients were examined before treatment and again one week after treatment. We analyzed how various general factors and ocular vestibular evoked myogenic potentials related to residual dizziness.

Results: Residual dizziness was not related to gender, affected side, age, duration of symptoms, recurrence, or the results of the initial ocular vestibular evoked myogenic potential test (p?>?.05). However, residual dizziness was significantly associated with the results of the second ocular vestibular evoked myogenic potential test (p?=?.007).

Conclusions: Residual dizziness after a successful canalith repositioning procedure may be caused by persistent utricular dysfunction.     

The test and treatment methods of benign paroxysmal positional vertigo and an addition to the management of vertigo due to the superior vestibular canal (BPPV‐SC)

A review of the tests and treatment manoeuvres for benign paroxysmal positional vertigo of the posterior, horizontal and superior vestibular canals is presented. Additionally, a new way to test and treat positional vertigo of the superior vestibular canal is presented. In a prospective study, 57 out of 305 patients' visits are reported. They had residual symptoms and dizziness after the test and the treatment of benign paroxysmal positional vertigo of the horizontal canal (BPPV‐HC) and posterior canal (PC). They were tested with a new test and treated with a new manoeuvre for superior canal benign paroxysmal positional vertigo (BPPV‐SC). Results for vertigo in 53 patients were good; motion sickness and acrophobia disappeared. Reactive neck tension to BPPV was relieved. Older people were numerous among patients and their quality of life (QOL) improved.     

眩晕头晕主诉患者中良性阵发性位置性眩晕的占比分析

研究分析良性阵发性位置性眩晕（BPPV）在眩晕头晕主诉患者的占比。     

Vestibular rehabilitation for migraine-associated dizziness

The purpose of this study was to investigate the effects of a vestibular rehabilitation program on patients with the diagnosis of migraine-associated dizziness. Subjects were placed in four groups as follows: idiopathic migraine-associated dizziness; idiopathic migraine-associated dizziness and associated benign positional vertigo; posttraumatic migraine-associated dizziness; and posttraumatic migraine-associated dizziness and benign positional vertigo. Vestibular rehabilitation therapy was administered to all patients. Criterion measurements included the dizziness handicap inventory, activities-specific balance confidence scale, computerized dynamic posturography performance, and dynamic gait index. After vestibular physical therapy, all subjects showed significant improvement in the dizziness handicap, activities-specific balance confidence, dynamic gait, and computerized dynamic posturography measures. Patients with migraine-associated dizziness can benefit from physical therapy intervention. The results of this study are important in considering the approach to vertiginous migraine patients with and without head injury.     

耳石症患者复位治疗成功后头晕观察

目的 观察后半规管耳石症（BPPV）患者经手法复位成功后,其头晕发生率及持续时间。方法 2009～2011年门诊确诊单侧后半规管BPPV手法复位成功患者418例,分成老年组（≥60岁）137例、青年组（<60岁）281例,分别观察两组头晕发生率及持续时间。结果 老年组头晕发生率45.3%（62/137）,青年组27%（76/281）,两组间差异有统计学意义（P<0.01）;头晕平均持续时间老年组（14.6±4.4）d,青年组（8.9±4.7）d,两组间差异有统计学意义（P<0.01）;老年组中女性头晕发生率43.3%（39/90）,男性48.9%（23/47）,两组间差异无统计学意义（P>0.05）;老年组中女性头晕平均持续时间（15.7±5.3）d,男性（14.7±4.6）d,两组间差异无统计学意义（P>0.05）。结论 老年BPPV患者复位治疗成功后头晕发生率明显高于青年组,头晕持续时间明显长于青年组;老年组头晕发生率及持续时间与性别无关。     

Utricular paresis and semicircular canal hyperactivity: a distinct otolith syndrome

Conclusions: Although combined utricular and canal paresis has been described previously, this is the first report of canal hyperactivity associated with utricular hypofunction. Unsteadiness and swaying were the most common symptoms, and patients with shorter duration of symptoms also had positional vertigo. We propose that this syndrome is a variant of utricular dysfunction and should be considered in the differential diagnosis of peripheral vestibular disorders. Objective: To describe a syndrome of instability associated with utricular dysfunction and hyperactive caloric responses. Methods: The study comprised 11 consecutive patients exhibiting abnormalities of the eccentric subjective visual vertical test (e-SVV) and high responses during the caloric test of the videonystagmography (VNG). We carried out a review of symptoms, physical examination, and vestibular tests. Results: There was no gender predilection or obvious etiology. The patients’ main complaint included instability with linear symptoms (i.e., tilting, rocking, and swaying), with positional vertigo as a secondary symptom. Oculomotor testing, visual fixation index, and brain MRI were normal, excluding a central nervous system disorder. VNG was essentially normal except for hyperactive responses during the caloric testing in all patients. Abnormal e-SVV was found in 10 patients unilaterally and bilaterally in 1 patient. Abnormal oVEMP was found in seven of seven patients, further supporting a utricular site of lesion.     

Betahistine add-on therapy for treatment of subjects with posterior benign paroxysmal positional vertigo: a randomized controlled trial

IntroductionBenign paroxysmal positional vertigo is a common vestibular disorder that accounts for one fifth of hospital admissions due to vertigo, although it is commonly undiagnosed.ObjectiveTo evaluate the effects of betahistine add-on therapy in the treatment of subjects with posterior benign paroxysmal positional vertigo.MethodsThis randomized controlled study was conducted in a population of 100 subjects with posterior benign paroxysmal positional vertigo. Subjects were divided into the Epley maneuver + betahistine group (group A) and Epley maneuver only (group B) group. Subjects were evaluated before and 1-week after the maneuver using a visual analog scale and dizziness handicap inventoryResultsOne hundred subjects completed the study protocol. The Epley maneuver had an overall success rate of 95% (96% in group A; 94% in group B, p = 0.024). Groups A and B had similar baseline visual analog scale scores (6.98 ± 2.133 and 6.27 ± 2.148, respectively, p = 0.100). After treatment, the visual analog scale score was significantly lower in both groups, and was significantly lower in group A than group B (0.74 ± 0.853 vs. 1.92 ± 1.288, respectively, p = 0.000). The change in visual analog scale score after treatment compared to baseline was also significantly greater in group A than group B (6.24 ± 2.01 vs. 4.34 ± 2.32, respectively, p = 0.000). The baseline dizziness handicap inventory values were also similar in groups A and B (55.60 ± 22.732 vs. 45.59 ± 17.049, respectively, p = 0.028). After treatment, they were significantly lower in both groups. The change in score after treatment compared to baseline was also significantly greater in group A than group B (52.44 ± 21.42 vs. 35.71 ± 13.51, respectively, p = 0.000).ConclusionThe Epley maneuver is effective for treatment of benign paroxysmal positional vertigo. Betahistine add-on treatment in posterior benign paroxysmal positional vertigo resulted in improvements in both visual analog scale score and dizziness handicap inventory.     

Patients with vertigo/dizziness of unknown origin during follow-ups by general otolaryngologists at outpatient town clinic

ObjectivesThe purpose of this study was to access the contribution of vertigo/dizziness-related patients’ interview and examinations during short-term hospitalization in determining the accurate final diagnosis of vertigo/dizziness of unknown origin.MethodsWe reviewed 1905 successive vertigo/dizziness patients at the Vertigo/Dizziness Center of Nara Medical University, who were introduced from general otolaryngologists at outpatient town clinic from May 2014 to April 2020. However, 244 patients were diagnosed with vertigo/dizziness of unknown origin (244/1905; 12.8%). Of these patients, 240 were hospitalized and underwent various examinations, including caloric test (C-test), video head impulse test (vHIT), vestibular evoked cervical myogenic potentials (cVEMP), subjective visual vertical (SVV), inner ear magnetic resonance imaging (ieMRI), Schellong test (S-test), and self-rating questionnaires of depression score (SDS).ResultsAccording to the examination data, together with interviewed vertigo/dizziness characteristics and daily changeable nystagmus findings, the final diagnoses were as follows: benign paroxysmal positional vertigo (BPPV: 107/240; 44.6%), orthostatic dysregulation (OD: 56/240; 23.3%), vestibular peripheral disease (VPD: 25/240; 10.4%), vestibular migraine (VM: 14/240; 5.8%), Meniere's disease (MD: 12/240; 5.0%), gravity perception disturbance (GPD: 10/240; 4.2%), psychogenic vertigo (Psycho: 10/240; 4.2%), and unknown (Unknown: 6/240; 2.5%). Supporting factors of final diagnosis was seen in gender, evoked dizziness, and positional nystagmus as BPPV; in evoked dizziness, S-test, and hypertension as OD; in evoked dizziness, head shaking after nystagmus, C-test, and vHIT as VPD; in gender, headache, and S-test as VM; in ear fullness and ieMRI as MD; in gender, evoked dizziness, and SVV as GPD; and in SDS as Psycho. To sum up, the ratios of Unknown were significantly reduced by this short-term hospitalization (244/1905→6/240).ConclusionsThe answer lists for vertigo/dizziness of unknown origin obtained in the present study may be helpful for future general otolaryngologists at outpatient town clinic to better attain an accurate final diagnosis.     

Otolith-ocular responses in patients with surgically confirmed unilateral peripheral vestibular loss

The chronic effects of unilateral peripheral vestibular loss (UPVL) are influenced by vestibular compensation. This study documents the balance-related symptoms and quantitative vestibular laboratory testing of 20 patients with surgically confirmed UPVL. Included are measures of the semicircular canal-ocular reflex, the otolith-ocular reflex, and both static and dynamic semicircular canal-otolith-interaction. This study differs from previous studies of patients with UPVL in that a large number of patients with surgically confirmed lesions were tested with three types of off-vertical axis rotation, several of the patients had anatomically preserved superior vestibular nerves, and self-perceived level of disability related to dizziness and imbalance were available. Results confirmed previously reported changes in the vestibulo-ocular reflex of patients with UPVL. Also, there was no apparent effect of anatomically preserving the superior vestibular nerve during surgical resection of vestibular schwannomas based on either subjective or objective measures of vestibular dysfunction. Further, there were no apparent correlations between subjective measures of dizziness and imbalance and objective measures of vestibulo-ocular function. These results have clinical implications for the management of patients with unilateral vestibular loss and provide insights into the process of vestibular compensation especially with respect to the otolith-ocular reflex.     

Testing utricular function by means of on-axis rotation

CONCLUSIONS: Subjective visual vertical (SVV) estimation during on-axis rotation provides an efficient screening test of utricle function. The survey demonstrates that isolated disorders of peripheral utricular function can occur while SCC function appears normal. OBJECTIVE: The present study aimed to investigate estimation of SVV during constant velocity yaw rotation (with the head held on-axis--to enhance any asymmetry between right and left utricular responses), as a useful screening test. MATERIALS AND METHODS: In all, 230 patients were recruited from the dizziness clinic. For each patient, the SVV was estimated (a) while held stationary, and (b) during constant angular velocity (240 degrees/s), with the head centred on-axis. Bithermal caloric testing was also performed in 201 of the patients. RESULTS: Of those patients with normal SVV results during stationary testing, 18.3% were pathological during rotation testing. In those cases with pathological SVV during stationary testing, a significantly greater deviation from the norm was observed during rotation (p<0.001). Of those patients with normal caloric responses, 44.4% showed pathological SVV estimates; this increased to 54.3% for cases with unilateral weakness, and 56.5% for unilateral loss. No clear correlation was found between reports of tilt illusion and pathological SVV, respectively, between rotatory vertigo and pathological caloric responses.     

Residual dizziness after successful repositioning maneuvers for idiopathic benign paroxysmal positional vertigo in the elderly

Even after successful repositioning maneuvers for benign paroxysmal positional vertigo (BPPV), some patients report dizziness lasting for a certain period afterwards. We studied the prevalence and clinical factors associated with residual dizziness in a sample of elderly patients. Sixty outpatients over 65 years of age, affected by idiopathic BPPV were recruited; the exclusion criterion was a history of previous episodes of vertigo, including positional. The patients were asked to describe their self-perceived anxiety for vertigo on a Visual Analogue Scale (VAS) and successively treated with appropriate maneuvers till resolution of nystagmus. Data concerning the demographic and clinical features of BPPV were collected. Patients were followed until complete resolution of subjective dizziness and imbalance without positional nystagmus. Data about residual dizziness were collected from the second day from resolution of BPPV. Clinical and demographic factors related to residual dizziness were analyzed. Twenty-two subjects (37%) reported residual dizziness. In these subjects, the mean duration of residual dizziness was 13.4 ± 7.5 days. No association was observed between residual dizziness and gender, involved canal and the number of repositioning maneuvers before resolution. On the other hand, age older than 72 years, symptom duration greater than 9 days and VAS scale for anxiety greater than 10/100 were associated with an increased risk of residual dizziness. The odds ratio were respectively 6.5 (age—residual dizziness, Confidence Interval 95%), 6.5 (duration of vertigo—residual dizziness, Confidence Interval 95%) and 15.5 (anxiety levels—residual dizziness, Confidence Interval 95%). Longer symptom duration before diagnosis was associated with higher anxiety levels. The results underline the necessity for an early and correct diagnosis of BPPV, especially in the elderly.     

Role of subjective visual vertical in patients with posterior canal benign paroxysmal positional vertigo as a prognostic marker after canalith repositioning maneuver

ObjectiveTo study the potential role of subjective visual vertical (SVV) as a prognostic marker for canalith repositioning maneuver (CRM) in patients with posterior canal benign paroxysmal positional vertigo (PC-BPPV) for the Indian population.MethodsSVV was examined in 30 patients with PC-BPPV before and after canalith repositioning maneuver and after complete resolution of PC-BPPV. Study parameters included the mean of 10 angular tilt readings and direction of deviation, which were compared before and after CRM and following complete resolution of PC-BPPV.ResultsThe angle of SVV tilt was greater and deviated towards the affected ear before CRM in all patients, which decreased significantly shortly after CRM and continued to decrease after complete resolution of PC-BPPV (p < 0.0001).ConclusionsSVV can be used to test utricular dysfunction in PC-BPPV. The angle of tilt improves in response to CRM, which may be used as a prognostic marker in patients with PC-BPPV receiving CRM.     

A randomized trial of the canalith repositioning procedure

OBJECTIVE: To compare the effectiveness and complications of our adaptation of the canalith repositioning procedure (CRP) with the expectation treatment for benign paroxysmal positional vertigo. STUDY DESIGN: A randomized, controlled trial in the setting of a neurotological clinic in Thailand. METHODS: Fifty-eight patients with posterior benign paroxysmal positional vertigo were randomly assigned to treatment and control groups using a block of four. The treatment group was treated with the modified CRP technique until the nystagmus disappeared. A mastoid oscillator was not used, nor were any instructions given for patients after the maneuver. Both groups recorded the daily grading of symptoms and the amount of anti-vertiginous drugs (cinnarizine) taken. Objective and subjective assessments were made weekly until the nystagmus disappeared or until 4 weeks had passed since treatment began. RESULTS: The rates of effectiveness of CRP treatment and the control treatment for benign paroxysmal positional vertigo were 75.9% and 48.2%, respectively. There was a significant difference in the treatment outcomes of the CRP and control groups (P =.03). The CRP group used significantly fewer drugs than the control group (P =.001). Complications in the CRP group, such as lateral canalithiasis and fainting, were observed in 13.8% of the patients. CONCLUSIONS: The CRP was more effective than the expectation treatment for benign paroxysmal positional vertigo insofar as it provided faster recovery and required less dependence on medication. Complications of CRP were limited to 13.8% of patients.