In 2006, study conducted by Burak O Cakir, et. al., which deals the effectiveness of postural restriction as an adjunct to canalith repositioning in treating benign paroxysmal positional vertigo (BPPV) has been investigated. This prospective trial aimed to shed light on the potential benefits of incorporating postural restrictions following the canalith repositioning procedure, a widely used method for BPPV treatment.

BPPV, a common vestibular disorder causing sudden bouts of dizziness and imbalance, has long been managed through the modified Epley canalith repositioning procedure. However, this study delved further by examining whether additional postural restrictions could enhance the therapeutic outcomes of this procedure.

The study comprised patients diagnosed with classic BPPV, as well as those with BPPV lacking nystagmus – involuntary eye movements often associated with vertigo. These patients were randomly assigned to two groups: one subjected to postural restrictions and another without any motion limitations post-treatment. The first group was instructed to don a cervical collar and maintain an upright head position for a duration of two days, while the second group experienced no such restrictions.

Following a five-day interval, patients were reevaluated using the Dix-Hallpike test, a diagnostic tool used to assess vertigo and its associated eye movements. The results unveiled noteworthy differences in treatment outcomes between the two groups.

In the group adhering to postural restrictions, a remarkable 56 out of 62 ears exhibited healing after just the initial maneuver. For the remaining cases, healing was achieved after a subsequent maneuver. On the other hand, the second group witnessed 45 out of 57 ears healing after the initial maneuver, with an additional 6 ears responding to the second maneuver. Intriguingly, 5 cases in the second group, which experienced delayed healing, were subsequently managed successfully through postural restrictions combined with a third maneuver. Importantly, only one ear failed to show improvement throughout the study.

Notably, a subset of patients in both groups experienced BPPV without nystagmus – a seemingly less severe form of the condition. Impressively, all patients in this subset healed after just a single maneuver, indicating the potential efficacy of the treatment for this subgroup.

Statistical analysis of the data demonstrated a significant distinction between the two groups concerning the number of maneuvers required for successful treatment (P<.05). Furthermore, the second group displayed a higher requirement for a third maneuver, underlining the added benefit of postural restrictions in the initial treatment phases.

While these findings highlight the potential therapeutic enhancement brought about by postural restriction in conjunction with canalith repositioning for posterior semicircular canal BPPV, the study acknowledges that the long-term efficacy of this approach in preventing BPPV recurrence remains to be demonstrated.

This groundbreaking study opens doors for future investigations into the broader applications of postural restrictions in managing BPPV and potentially other vestibular disorders, offering fresh perspectives on optimizing treatment protocols and enhancing patient outcomes.

Reference: Çakır, B. Ö., Ercan, I., Çakır, Z. A., & Turgut, S. (2006). Efficacy of postural restriction in treating benign paroxysmal positional vertigo. Archives of Otolaryngology–Head & Neck Surgery, 132(5), 501-505.