title: Canalith repositioning procedures among 965 patients with benign paroxysmal positional vertigo.
abstract: BACKGROUND
  Canalith repositioning procedure (CRP) has increasingly been utilized for the last 15 years for the treatment of benign paroxysmal positional vertigo (BPPV). We assess the short- and long-term efficacy of CRP on the treatment of patients with BPPV.
  
  
  METHODS
  Nine hundred sixty-five patients (481 men and 484 women, from 18 to 87 years of age) were enrolled in this prospective study during 1995-2010. Inclusion criteria were a patient history compatible with BPPV and a positive provocative maneuver (either Dix-Hallpike or Roll test). Reported duration of symptoms at the time of their first examination varied from 1 day to 18 months. Variants of the Epley and Barbeque maneuver were used for posterior and anterior canal involvement, and horizontal canal involvement, respectively. Short-term follow-up was obtained 48 h and 7 days after initial treatment, whereas long-term follow-up was obtained at repeated 6-month intervals.
  
  
  RESULTS
  Symptoms subsided immediately in 819 patients (85%) by the first CRP. Only 19 patients (2%) required CRP more than 3 times. Patients' mean follow-up was 74 months; symptom recurrence was noted in 139 patients. A statistically significantly higher recurrence rate was noted in elderly people or those with head trauma or a history of vestibular neuropathy (p<0.001).
  
  
  CONCLUSIONS
  This study provides class IV evidence that CRP remains an efficient and long-lasting noninvasive treatment for BPPV, especially for younger patients without a history of head trauma or vestibular neuropathy. Elderly people have a significantly higher recurrence rate requiring additional education to minimize potential morbidity of their falls.
authors.affiliation: Department of Otorhinolaryngology, University of Crete School of Medicine, Heraklion, Greece. emmanuel@prokopakis.gr
authors.forename: E
authors.initials: E
authors.lastname: Prokopakis
authors.forename: I M
authors.initials: IM
authors.lastname: Vlastos
authors.forename: M
authors.initials: M
authors.lastname: Tsagournisakis
authors.forename: P
authors.initials: P
authors.lastname: Christodoulou
authors.forename: H
authors.initials: H
authors.lastname: Kawauchi
authors.forename: G
authors.initials: G
authors.lastname: Velegrakis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065635:Benign Paroxysmal Positional Vertigo; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D056888:Patient Positioning / Q000379:methods*; D011446:Prospective Studies; D012008:Recurrence; D012665:Semicircular Canals / Q000503:physiopathology*; D016896:Treatment Outcome; D014717:Vertigo / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy*; D055815:Young Adult