title: 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.
abstract: 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).
  
  
  METHODS
  Randomized prospective clinical trial.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  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.
  
  
  METHODS
  Forty-one patients were treated with a single PRM and 40 patients by B-D exercise.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.affiliation: Otolaryngology Division, University Hospital Lucus Augusti, University Hospital Lucus Augusti, Lugo, Spain. Juan.Carlos.Amor.Dorado@sergas.es
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Amor-Dorado
authors.forename: Maria Pilar
authors.initials: MP
authors.lastname: Barreira-Fernández
authors.forename: Ismael
authors.initials: I
authors.lastname: Aran-Gonzalez
authors.forename: Emilio
authors.initials: E
authors.lastname: Casariego-Vales
authors.forename: Javier
authors.initials: J
authors.lastname: Llorca
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: González-Gay
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065635:Benign Paroxysmal Positional Vertigo; D015331:Cohort Studies; D005133:Eye Movements / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D026741:Physical Therapy Modalities / Q000009:adverse effects; D011446:Prospective Studies; D012008:Recurrence; D012665:Semicircular Canals; D016037:Single-Blind Method; D016896:Treatment Outcome; D014717:Vertigo / Q000628:therapy*; D055815:Young Adult