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From the MRC Human Movement and Balance Unit (Drs. Lempert, Gresty, and Bronstein and C. Wolsley) and the Department of Neuro-Otology (Dr. Davies), National Hospital for Neurology and Neurosurgery, London, UK.
Address correspondence and reprint requests to Dr. Thomas Lempert, Neurologische Abteilung, Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
The canalithiasis hypothesis proposes that benign positional vertigo (BPV) is caused by dislodged otoconia that settle in the posterior semicircular canal (PSC). When head position is changed these particles move within the canal and induce abnormal endolymph flow. To clear the PSC from debris we developed a procedure that consists of a full circle of backward head rotation in the exact plane of the canal. Patients were seated in a three-dimensional motion device that rotated in steps of 110 degrees every 30 seconds. The first part of the study was conducted as an open trial; the second part followed a single-blinded, placebo-controlled design: Forward rotation (placebo) was applied first and backward rotation was applied 1 week later if BPV persisted. All patients were assessed with a symptom diary and, in the controlled trial, also with the Dix-Hallpike maneuver. In the open study 10 of 15 patients became asymptomatic after one treatment session. In the controlled trial all 15 patients remained symptomatic after forward rotation while 10 of 14 undergoing backward rotation were relieved from positional vertigo immediately (p = 0.004). The presence of secondary nystagmus during the procedure indicated a favorable outcome. Our findings provide evidence for the efficacy of canal-clearing procedures that validate the canalithiasis hypothesis of BPV.
Supported by the Deutsche Forschungsgemeinschaft (TL) and by a large-scale facilities grant from the Commission of the European Community (CEC).
Received October 11, 1996. Accepted in final form March 12, 1997.
This article has been cited by other articles:
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  T. D. Fife, D. J. Iverson, T. Lempert, J. M. Furman, R. W. Baloh, R. J. Tusa, T. C. Hain, S. Herdman, M. J. Morrow, and G. S. Gronseth Practice Parameter: Therapies for benign paroxysmal positional vertigo (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology Neurology, May 27, 2008; 70(22): 2067 - 2074. [Full Text] [PDF]
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S. T. Aw, M. J. Todd, G. E. Aw, L. A. McGarvie, and G. M. Halmagyi Benign positional nystagmus: A study of its three-dimensional spatio-temporal characteristics Neurology, June 14, 2005; 64(11): 1897 - 1905. [Abstract] [Full Text] [PDF]
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 P Bertholon, A M Bronstein, R A Davies, P Rudge, and K V Thilo Positional down beating nystagmus in 50 patients: cerebellar disorders and possible anterior semicircular canalithiasis J. Neurol. Neurosurg. Psychiatry, March 1, 2002; 72(3): 366 - 372. [Abstract] [Full Text] [PDF]
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 J. M. Furman and S. P. Cass Benign Paroxysmal Positional Vertigo N. Engl. J. Med., November 18, 1999; 341(21): 1590 - 1596. [Full Text] [PDF]
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A. Radtke, H. Neuhauser, M. von Brevern, and T. Lempert A modified Epley's procedure for self-treatment of benign paroxysmal positional vertigo Neurology, October 1, 1999; 53(6): 1358 - 1358. [Abstract] [Full Text] [PDF]
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 A TREATMENT FOR BENIGN POSITIONAL VERTIGO Journal Watch (General), October 7, 1997; 1997(1007): 7 - 7. [Full Text]
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