Treatment of apogeotropic benign positional vertigo: comparison of therapeutic head-shaking and modified Semont maneuver.
Several methods of physiotherapy have been advanced for apogeotropic type benign positional vertigo involving the horizontal semicircular canal (HC-BPV). The aim of this study was to determine the therapeutic efficacies of the proposed maneuvers in apogeotropic HC-BPV. Using a prospective randomized trial involving seven nationwide dizziness clinics in Korea, we compared the immediate efficacies of head-shaking and modified Semont maneuvers in 103 consecutive patients with apogeotropic HC-BPV. We also determined an additional therapeutic benefit of mastoid oscillation while the patients without response to both maneuvers were performing the Brandt-Daroff exercise. Successful treatment was defined as resolution of positional vertigo and nystagmus, or as transition into geotropic HC-BPV. Results showed that head shaking was more effective than the modified Semont maneuver (37.3 vs. 17.3%, P = 0.02). However, therapeutic efficacy did not differ between the maneuvers after the initial non-responders switched over to the other maneuver (23.3 vs. 25.0%, P = 0.861). Mastoid oscillation provided no additional benefit while the patients without response to both maneuvers were performing the Brandt-Daroff exercise. Most positional vertigos resolved within a week (89.4%) irrespective of the treatment modalities applied and all showed resolution within 28 days. The head-shaking maneuver described here proved more effective than the modified Semont maneuver in treating apogeotropic HC-BPV. Mastoid vibration conferred no additional benefit during the Brandt-Daroff exercise.
Department of Neurology, School of Medicine, Chonbuk National University, Jeonju, South Korea.
S-Y
SY
Oh
Ji-Soo
JS
Kim
S-H
SH
Jeong
Y-M
YM
Oh
K-D
KD
Choi
B-K
BK
Kim
S-H
SH
Lee
H-S
HS
Lee
I-S
IS
Moon
J-J
JJ
Lee
D000328:Adult; D000368:Aged; D005081:Exercise Therapy / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D019416:Head Movements / Q000502:physiology*; D006801:Humans; D008297:Male; D008416:Mastoid / Q000033:anatomy & histology / Q000502:physiology; D008875:Middle Aged; D009759:Nystagmus, Pathologic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data*; D011187:Posture / Q000502:physiology; D011446:Prospective Studies; D012665:Semicircular Canals / Q000503:physiopathology; D016896:Treatment Outcome; D014717:Vertigo / Q000503:physiopathology / Q000628:therapy*; D014722:Vestibule, Labyrinth / Q000503:physiopathology; D014732:Vibration / Q000627:therapeutic use; D055815:Young Adult