National Medical Policy

Subject:

Particle Repositioning Maneuvers for Benign

Paroxysmal Positional Vertigo (BPPV)

Policy Number:

NMP452

Effective Date*: April 2009

Updated:

July 2014
This National Medical Policy is subject to the terms in the
IMPORTANT NOTICE
at the end of this document

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The Centers for Medicare & Medicaid Services (CMS)
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guidelines first:
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(NCD)
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(LCD)*
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Particle Repositioning Maneuvers for Benign Paroxysmal Positional Vertigo (BPPV)
Jul 14

Current Policy Statement

Health Net Inc. considers Particle Repositioning Maneuvers [i.e., Canalith
repositioning procedure (Epley maneuver) or Semont maneuver] medically necessary
for the treatment of Benign Paroxysmal Positional Vertigo confirmed by a positive
Dix-Hallpike test.

Abbreviations
BPPV
PRM
CRP
QOL
DHI
CI

Benign Paroxysmal Positional Vertigo

Particle repositioning maneuvers
Canalith repositioning procedure
Quality of life
Dizziness handicap inventory
Confidence interval

Codes Related To This Policy

NOTE:
The codes listed in this policy are for reference purposes only. Listing of a code in
this policy does not imply that the service described by this code is a covered or noncovered health service. Coverage is determined by the benefit documents and
medical necessity criteria. This list of codes may not be all inclusive.
On October 1, 2015, the ICD-9 code sets used to report medical diagnoses and
inpatient procedures will be replaced by ICD-10 code sets. Health Net National
Medical Policies will now include the preliminary ICD-10 codes in preparation for this
transition. Please note that these may not be the final versions of the codes and
that will not be accepted for billing or payment purposes until the October 1, 2015
implementation date.

ICD-9 Codes
386.11
780.4

Benign paroxysmal positional vertigo

Dizziness and giddiness

ICD- 10 Codes
H81.10-H81.13
R42

Benign paroxysmal vertigo

Dizziness and giddiness

CPT Codes
95992

HCPCS Codes

Canalith repositioning procedure(s), (eg, Epley maneuver,

Semont maneuver), per day

N/A

Scientific Rationale - Update July 2013

Wang et al (2013) sought to demonstrate the current status of benign paroxysmal
positional vertigo (BPPV) management and the advantages of repositioning
maneuvers as well as to facilitate the accurate and efficient diagnosis and
management of BPPV. Of 131 participants with severe dizziness/vertigo who were
examined and treated, 31 (23.7 %) fulfilled the diagnostic criteria for BPPV. All
patients in the study had a diagnosis of BPPV confirmed by their history, typical
subjective symptom reports, and characteristic positional nystagmus during the DixHallpike test and/or roll test. All participants were comprehensively interviewed
regarding their medical history, characteristics of the first attack of vertigo,
associated symptoms, previous financial costs, and number of hospital visits. The
average duration from the appearance of the first symptoms until a final diagnostic
Particle Repositioning Maneuvers for Benign Paroxysmal Positional Vertigo (BPPV)
Jul 14

positional maneuver was >70 months. On average, patients visited hospitals more
than eight times before the final diagnosis due to initial visits to inappropriate
departments, including neurology, emergency, orthopaedic surgery, and Traditional
Chinese Medicine, with a corresponding average financial cost of more than 5,000
RMB. The canalith repositioning procedure (CRP) was effective in 80.65 % of patients
after the first repositioning maneuver. Our data demonstrated that despite the
significant prevalence of BPPV, delays in diagnosis and treatment frequently occur,
which have both cost and quality-of-life impacts on both patients and their
caregivers. The CRP is very effective for patients with BPPV. It is important for
patients to pay more attention to the impact of BPPV on their lives and recognize its
nature to ensure compliant follow-up in otolaryngology.
Prokopakis et al (2013) assessed the short- and long-term efficacy of CRP on the
treatment of patients with BPPV. 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. 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). Investigators concluded the 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.
Babac and Arsovi (2013) examined the efficacy of the Epley maneuver in treating
benign paroxysmal positional vertigo of the posterior semicircular canal (p-BPPV) and
to discover possible causes of failure. This prospective study included 75 patients. In
all the cases medical history showed and the positioning Dix-Hallpike test confirmed
the diagnosis of p-BPPV. We also performed clinical ENT examination, searching for
spontaneous nystagmus, vestibulospinal tests, caloric test, and audiometry. All the
patients were treated by the modified Epley canalith repositioning maneuver. The
patients were followed up at the intervals of seven and, fourteen days, and one,
tree, and six months and one year. The maneuver was repeated if vertigo and
nystagmus on control positioning test persisted. The transition from positive into
negative Dix Hallpike test after one or two Epley maneuver was considered as
success in treatment. After the initial Epley maneuver the recovery rate was 90.7%,
and after the second 96%. In three (4%) patients with secondary p-BPPV, symptoms
did not cease even after the second repositioning maneuver. The etiology of p-BPPV
had a significant effect on the maneuver's success rate (p < 0.01), whereas duration
of symptoms, age and gender had no effect (p > 0.05). After a successful treatment
11 (14.66%) patients had recurrent attack of BPPV during the first year.
Investigators concluded the Epley maneuver is very successful repositioning
procedure in treating p-BPPV. The patients with idiopathic form p-BPPV showed
higher success rate with Epley maneuver than those with secondary p-BPPV.

Scientific Rationale - Update July 2012

Particle Repositioning Maneuvers for Benign Paroxysmal Positional Vertigo (BPPV)
Jul 14

Do et al (2012) enrolled 138 consecutive patients who had been diagnosed with
BPPV in the emergency rooms and ENT out-patient clinics from January to June
2009. All patients immediately underwent appropriate canalith repositioning
procedures (CRPs) depending on canalith type and location. The CRPs were
performed daily until the patient's symptoms were resolved. The patients were
classified into two groups according to the duration between symptom onset and
initial treatment: less than 24 hours (early repositioning group, n=66) and greater
24 hours (delayed repositioning group, n=72). Investigators compared the numbers
of treatments received and the recurrence rates between the two groups. Follow-up
periods ranged from 8 to 14 months, 77 cases involved posterior canal BPPV, 48
cases were lateral canal BPPV (of which 20 cases were cupulolithiasis), and 13 cases
were multiple canal BPPV. BPPV recurrence was found in a total of 46 patients
(33.3%). The necessary numbers of CRPs were 2.3 for the early repositioning group
and 2.5 for the late repositioning group, a difference that was not statistically
significant (P=0.582). The early repositioning group showed a recurrence rate of
19.7%, and the delayed repositioning group showed a recurrence rate of 45.8%
(P=0.002). Investigators concluded performing repositioning treatments as soon as
possible after symptom onset may be an important factor in the prevention of BPVV
recurrence.
Guo et al (2011) explored the effect of CRP on the quality of life (QOL) in patients
with BPPV. The clinical data of 86 patients with BPPV (treatment group) and 120
normal ones (control group) were reviewed through the medical outcomes study
short form (SF-36) and the dizziness handicap inventory (DHI), and the results of
two groups were analyzed. With SF-36 scales for evaluation of QOL, the results
showed that the scores of treatment group before CRP were significantly lower than
that of the control group (P < 0.05). While using of DHI scales in evaluation of the
treatment group patients before CRP, the results were significantly higher than that
of the control group (P < 0.05). After CRP for 3 months, not only with SF-36 scales
but also with DHI scales, there were no significant difference between the two
groups (P > 0.05). Investigators concluded CRP may obviously improve the clinical
symptom of BPPV patients. The SF-36 and DHI scales could reflect the change of
BPPV patient's QOL.
In a Cochrane review, Hunt et al (2012) assessed whether the various modifications
of the Epley maneuver for posterior canal BPPV enhance its efficacy in clinical
practice. Randomized controlled trials of modifications of the Epley maneuver versus
a standard Epley maneuver as a control in adults with posterior canal BPPV
diagnosed with a positive Dix-Hallpike test. Specific modifications sought were:
application of vibration/oscillation to the mastoid region, vestibular rehabilitation
exercises, additional steps in the Epley maneuver and post-treatment instructions
relating to movement restriction. Two authors independently selected studies from
the search results and the third author reviewed and resolved any disagreement.
Two authors independently extracted data from the studies using standardized data
forms. All authors independently assessed the trials for risk of bias. The review
includes 11 trials involving 855 participants. A total of nine studies used post-Epley
postural restrictions as their modification of the Epley maneuver. There was no
evidence of a difference in the results for post-treatment vertigo intensity or
subjective assessment of improvement in individual or pooled data. All nine trials
included the conversion of a positive to a negative Dix-Hallpike test as an outcome
measure. Pooled data identified a significant difference from the addition of postural
restrictions in the frequency of Dix-Hallpike conversion when compared to the Epley
maneuver alone. In the experimental group 88.7% (220 out of 248) patients versus
78.2% (219 out of 280) in the control group converted from a positive to negative
Dix-Hallpike test (risk ratio (RR) 1.13, 95% confidence interval (CI) 1.05 to 1.22, P
Particle Repositioning Maneuvers for Benign Paroxysmal Positional Vertigo (BPPV)
Jul 14

= 0.002). No serious adverse effects were reported, however three studies reported
minor complications such as neck stiffness, horizontal BPPV, dizziness and
disequilibrium in some patients. There was no evidence of benefit of mastoid
oscillation applied during the Epley maneuver, or of additional steps in the Epley
maneuver. No adverse effects were reported. Reviewers concluded there is evidence
supporting a statistically significant effect of post-Epley postural restrictions in
comparison to the Epley maneuver alone. However, it important to note that this
statistically significant effect only highlights a small improvement in treatment
efficacy. An Epley maneuver alone is effective in just under 80% of patients with
typical BPPV. The additional intervention of postural restrictions has a number
needed to treat (NNT) of 10. The addition of postural restrictions does not expose
the majority of patients to risk of harm, does not pose a major inconvenience, and
can be routinely discussed and advised. Specific patients who experience discomfort
due to wearing a cervical collar and inconvenience in sleeping upright may be treated
with the Epley maneuver alone and still expect to be cured in most instances. There
is insufficient evidence to support the routine application of mastoid oscillation during
the Epley maneuver, or additional steps in an augmented' Epley maneuver. Neither
treatment is associated with adverse outcomes. They suggested further studies
should employ a rigorous randomization technique, blinded outcome assessment, a
post-treatment Dix-Hallpike test as an outcome measure and longer-term follow-up
of patients.

Scientific Rationale
Benign paroxysmal positional vertigo (BPPV), also termed benign positional vertigo,
paroxysmal positional vertigo, positional vertigo, benign paroxysmal nystagmus, and
paroxysmal positional nystagmus, is characterized by repeated episodes of vertigo
triggered by changes in head position with respect to gravity. These episodes may or
may not be associated with nausea and vomiting. BPPV is the most common cause
of recurrent vertigo. BPPV is most commonly clinically encountered as one of two
variants: BPPV of the posterior semicircular canal (posterior canal BPPV) or BPPV of
the lateral semicircular canal (also known as horizontal canal BPPV). Another variant,
anterior canal BPPV is usually transitory and most oftern the result of a canal
switch that occurs in the course of treating other more common forms of BPPV (i.e.
posterior or horizontal BPPV). Posterior canal BPPV is the most common form of
BPPV and is idiopathic in 35 percent of cases. The term BPPV excludes vertigo
caused by lesions of the CNS.
The symptoms of vertigo resulting from posterior canal BPPV are typically described
by the patient as a rotational or spinning sensation when the patient changes head
position relative to gravity. The episodes are often provoked by everyday activities
and commonly occur when rolling over in bed or when the patient is tilting the head
to look upward (eg, to place an object on a shelf higher than the head) or bending
forward (eg, to tie shoes).
The etiology of BPPV is thought to be attributed to calcium debris within the posterior
semicircular canal, known as canalithiasis. This debris likely represents loose
otoconia (calcium carbonate crystals) within the semicircular canals, which is
dislodged from the otolith organs by trauma, infection, or degeneration. The
otoconial debris can move about after changes in head position, causing vertigo and
nystagmus when the debris tumbles through the semicircular canals. The duration of
symptoms is brief because dizziness occurs only while the debris shifts position.
The Dix-Hallpike maneuver is considered the gold standard test for the diagnosis of
posterior canal BPPV. The Dix-Hallpike maneuver is performed by bringing the
patient from an upright to supine position with the head turned 45 degrees to one
5
Particle Repositioning Maneuvers for Benign Paroxysmal Positional Vertigo (BPPV)
Jul 14

side and neck extended 20 degrees. The diagnosis is confirmed when vertigo
associated with nystagmus is provoked by this maneuver. The fast component of
the nystagmus provoked by the Dix-Hallpike maneuver demonstrates a characteristic
mixed torsional and vertical movement (often described as upbeating- torsional),
with the upper pole of the eye beating toward the dependent ear and the vertical
component beating toward the forehead. Temporally, the rate of nystagmus
typically begins gently, increases in intensity, and then declines in intensity as it
resolves. This has been termed crescendo-decrescendo nystagmus. The nystagmus
is again commonly observed after the patient returns to the upright head position
and upon arising, but the direction of the nystagmus may be reversed. The DixHallpike test must be done bilaterally to determine which ear is involved or if both
ears are involved. Although the Dix-Hallpike maneuver is the test of choice
to confirm the diagnosis of posterior canal BPPV, it should be avoided in certain
circumstances (e.g., patients with significant vascular disease, cervical stenosis,
severe kyphoscoliosis, etc).
Patients with a history compatible with BPPV who do not meet diagnostic criteria for
posterior canal BPPV should be investigated for lateral canal BPPV, also referred to as
horizontal canal BPPV. The supine roll test is the preferred maneuver to diagnose
lateral canal BPPV. The supine roll test is performed by initially positioning the
patient supine with the head in neutral position followed by quickly rotating the head
90 degrees to one side with the clinician observing the patients eyes for nystagmus.
After the nystagmus subsides (or if no nystagmus is elicited), the head is then
returned to the straight face up supine position. After any additional elicited
nystagmus has subsided, the head is then quickly turned 90 degrees to the opposite
side, and the eyes are once again observed for nystagmus. Two potential nystagmus
findings may occur with this maneuver, reflecting two types of lateral canal BPPV
(i.e., geotropic and apogeotropic)
Treatment of posterior canal BPPV includes particle repositioning maneuvers (RPM).
Two types of PRMs have been found effective for posterior canal BPPV: the canalith
repositioning procedure (CRP, also referred to as the Epley maneuver) and the
liberatory maneuver (also called the Semont maneuver). Other PRMs have been
proposed for the treatment of posterior canal BPPV, but high-quality, reproducible
data that demonstrate their clinical efficacies are lacking.
Through a series of head position changes, the CRP moves the canaliths from the
posterior semicircular canal to the vestibule, thereby relieving the stimulus from the
semicircular canal that had been producing the vertigo in BPPV. Nausea, occasional
vomiting, and/or a sense of falling may arise during the CRP. Adverse effects may
include nausea, vomiting, fainting, and conversion to lateral canal BPPV during the
course of treatment (so-called canal switch). According to the American Academy of
Otolaryngngology-Head and Neck Surgeons, it is not possible to determine the
optimal number of cycles for the CRP or a protocol for repeated procedures and the
need for repeated applications should be determined by the severity of the
symptoms, if they persist.
Several RCTs have been published evaluating the efficacy of the CRP in the
treatment of posterior canal BPPV. Studies have demonstrated a short-term
resolution of symptoms. Considerable variability exists in terms of the number of
times the CRP is applied for the initial treatment of BPPV, even across RCTs.
Consistent with the expected spontaneous resolution of posterior canal BPPV over
time, treatment effects between CRP and control patients tended to diminish over
time. In the short term, typically at 1 week, the CRP is very effective at providing
symptom resolution for posterior canal BPPV with small numbers needed to treat.
Particle Repositioning Maneuvers for Benign Paroxysmal Positional Vertigo (BPPV)
Jul 14

A Cochrane review, reported by Hilton and Binder (2004) assessed the effectiveness
of the Epley maneuver compared to other treatments available for posterior canal
benign paroxysmal positional vertigo, or no treatment. Randomised trials of adults
diagnosed with posterior canal BPPV (including a positive Dix-Hallpike test) treated
with the Epley maneuver versus placebo, untreated controls or other active
treatment were identified. Outcome measures considered included: frequency and
severity of attacks of vertigo; proportion of patients improved by each intervention;
and conversion of a "positive" Dix-Hallpike test to a "negative" Dix-Hallpike test.
Fifteen trials were identified but twelve studies were excluded because of a high risk
of bias (e.g., inadequate concealment during randomisation, or failure to blind
outcome assessors), leaving three trials in the review. The studies included in the
review (Lynn 1995; Froehling 2000; Yimtae 2003) addressed the efficacy of the
Epley maneuver against a sham maneuver or control group by comparing the
proportion of subjects in each group who had complete resolution of their symptoms,
and who converted from a positive to negative Dix-Hallpike test. Individual and
pooled data showed a statistically significant effect in favor of the Epley maneuver
over controls. There were no serious adverse effects of treatment. The reviewer
concluded that there is some evidence that the Epley maneuver is a safe effective
treatment for posterior canal BPPV, although based on the results of three small
randomised controlled trials with relatively short follow up. They also concluded that
it is unclear if the Epley maneuver provides a long-term resolution of symptoms. In
addition, comparative studies of the Epley maneuver with other physical, medical or
surgical therapy for posterior canal BPPV is also lacking.
In a randomized prospective, double-blind, sham-controlled trial, Munoz et al (2007)
investigated eighty-one patients, 18 years or older, whose dizziness was confirmed
by the Dix-Hallpike (DH) and who had no contraindications to the CRM. CRM was
performed by family physicians in a primary care setting. At the first visit, patients
were randomized and the intervention group received the CRM and the control group
received a sham maneuver. Both groups received the CRM at the second and third
visits, 1 and 2 weeks later. After the first treatment, 34.2% of patients in the
intervention group and 14.6% of patients in the control group had negative DH test
results and 31.6% of patients in the intervention group and 24.4% of patients in the
control group reported resolution of dizziness. One week later, patients in both
intervention and control groups received the CRM, and 61.8% and 57.1% of them,
respectively, had negative DH test results. By week 3, approximately 75% of
patients in both groups had improved. The investigator consluded that a statistically
significant proportion of patients in the CRM group returned to a negative response
to the DH maneuver immediately after the first treatment. Family physicians can use
the CRM to treat benign paroxysmal positional vertigo and potentially avoid delays in
treatment and unnecessary referrals.
The positive treatment results of CRP has also been demonstrated in lesser quality
nonrandomized trials and case series. Four meta-analyses each concluded that the
CRP is significantly more effective than placebo in posterior canal BPPV. Among these
trials, however, significant heterogeneity has been demonstrated.
An evidence-based review on therapies for BPPV from the American Academy of
Neurology (AAN) reported the following:
Canalith repositioning procedure is established as an effective and safe
therapy that should be offered to patients of all ages with posterior
semicircular canal BPPV (Level A recommendation).
Particle Repositioning Maneuvers for Benign Paroxysmal Positional Vertigo (BPPV)
Jul 14

According to a Clinical practice guidelines on BVVP from the American Academy of

Otolaryngology-Head and Neck Surgery:
Although BPPV is benign and is likely to spontaneously remit in the
subsequent months, recent relatively high-quality evidence supports active,
expeditious treatment with a particle repositioning maneuver (PRM).
Treatment with PRMs consistently eliminates the vertigo due to BPPV,
improves quality of life, and reduces the risks of falling.
Clinical trials concerning the treatment effectiveness of the liberatory maneuver
(Semont maneuver) are limited. Cohen et al (2005) included a treatment arm with
the Semont maneuver, demonstrated that this maneuver improved vertigo intensity
more than the sham treatment. Salvinelli et al (2003) randomized 156 patients to
the Semont maneuver, flunarizine (a calcium channel blocker), or no treatment. At
6-month follow-up, symptom resolution occurred in 94.2 percent of patients treated
with the Semont maneuver, 57.7 percent of patients treated with flunarizine, and
34.6 percent of untreated patients. Soto Varela et al (2001) randomized patients to
treatment with CRP, Semont maneuver, or Brandt-Daroff exercises. Symptom
resolution among those treated with either CRP or Semont maneuver at 1 week was
the same (74% vs 71%) but only 24 percent for Brandt-Daroff exercises. At 3-month
follow-up, however, patients treated with CRP demonstrated superior outcomes
compared with those treated with Semont maneuver.
An evidence - based review, the American Academy of Neurology (AAN) reported the
following:
The Semont maneuver is possibly effective for BPPV but receives only a Level
C recommendation based on a single Class II study. Although many experts
believe that the Semont maneuver is as effective as canalith repositioning
maneuver, based on currently published articles the Semont maneuver can
only be classified as possibly effective. There is insufficient evidence to
establish the relative efficacy of the Semont maneuver to CRP.
According to the American Academy of Ootolaryngology-Head and Neck Surgery:
The Semont maneuver is more effective than no treatment or Brandt-Daroff
exercises in relieving symptoms of posterior canal BPPV, according to studies
with small sample sizes and limitations. No adverse events have been
reported in trials with the liberatory maneuver. Because of limited studies
with direct comparisons between the liberatory maneuver and the CRP, no
conclusions about differential effectiveness can be drawn.
Lateral canal BPPV is usually unresponsive to CRPs used for posterior canal BPPV but
may respond to other maneuvers intended to move canaliths from the lateral canal
into the vestibule. The roll maneuver (Lempert maneuver or barbecue roll
maneuver) or its variations are the most commonly employed maneuvers for the
treatment of lateral canal BPPV. This maneuver involves rolling the patient 360
degrees in a series of steps to effect particle repositioning. Limited data exist with
respect to the effectiveness of the roll maneuver in lateral canal BPPV treatment.
Based primarily on cohort studies and case series, the reported response rates vary
widely from 50 percent to almost 100 percent. Forced prolonged positioning is
another treatment maneuver reported to be as effective in treating lateral canal
BPPV. It may be performed either alone or concurrently with other maneuvers with a
reported effectiveness of 75-90 percent based on case series. The Gufoni maneuver,

Particle Repositioning Maneuvers for Benign Paroxysmal Positional Vertigo (BPPV)

Jul 14

is another technique that has been reported as effective in treating horizontal canal
BPPV. The AAN reports that these maneuvers may be effective for horizontal BPPV
but evidence is limited.
The Brandt and Daroff exercises can be taught for home use. These home
repositioning exercises involve a sequence of rapid lateral head/trunk tilts repeated
serially to promote loosening and ultimately dispersion of debris toward the utricular
cavity. In these exercises, the patient starts in a sitting position and moves quickly
to the right-side lying position, with the head rotated 45 degrees and facing upward.
This position is maintained for 30 seconds after the vertigo stops. The patient then
moves rapidly to a left-side lying position, with the head rotated 45 degrees and
facing upward.

Review History
April 2009
March 2011
July 2011
July 2012
July 2013
July 2014

Medical Advisory Council, initial approval

Update no revisions
Update no revisions
Update no revisions
Update no revisions. Code updates.
Update no revisions. Code updates.

This policy is based on the following evidence-based guidelines:

1.
2.
3.

Hayes. Medical Technology Directory. Vestibular Rehabilitation for the Treatment

of Vestibular and Balance Disorders. September 7, 2005. Archived 2006.
Bhattacharyya N, Baugh R, Orvidas L et al. Clinical practice guideline: Benign
paroxysmal positional vertigo. OtolaryngologyHead and Neck Surgery (2008)
139, S47-S81.
Fife TD, Iverson DJ, Lempert T et al. 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
2008 May 27; 70(22): 2067-74. Available at:
http://www.neurology.org/cgi/reprint/70/22/2067.pdf

References Update July 2014

1.

2.

Bruintjes TD, Companjen J, van der Zaag-Loonen HJ, van Benthem PP. A
randomised sham-controlled trial to assess the long-term effect of the Epley
manoeuvre for treatment of posterior canal BPPV. Clin Otolaryngol.
2014;39(1):39-44.
Huebner AC, Lytle SR, Doettl SM, etal. Treatment of objective and subjective
benign paroxysmal positional vertigo. J Am Acad Audiol. 2013;24(7):600-606.

References Update July 2013

1.
2.
3.
4.

Babac S, Arsovi N. Efficacy of Epley maneuver in treatment of benign

paroxysmal positional vertigo of the posterior semicircular canal. Vojnosanit
Pregl. 2012 Aug; 69(8):669-74.
Babic BB, Jesic SD, Milovanovic JD, Arsovic NA. Unintentional conversion of
benign paroxysmal positional vertigo caused by repositioning procedures for
canalithiasis: transitional BPPV. Eur Arch Otorhinolaryngol. 2013 Apr 19.
Kerber KA, Burke JF, Skolarus LE, et al. Use of BPPV processes in emergency
department dizziness presentations: a population-based study. Otolaryngol
Head Neck Surg. 2013 Mar;148(3):425-30.
Prokopakis E, Vlastos IM, Tsagournisakis M, et al. Canalith repositioning
procedures among 965 patients with benign paroxysmal positional vertigo.
Audiol Neurootol. 2013;18(2):83-8.

Particle Repositioning Maneuvers for Benign Paroxysmal Positional Vertigo (BPPV)

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5.

Wang H, Yu D, Song N, Su K, Yin S. Delayed diagnosis and treatment of benign

paroxysmal positional vertigo associated with current practice. Eur Arch
Otorhinolaryngol. 2013 Mar 2.

References Update July 2012

1.

2.
3.
4.
5.
6.
7.

Do YK, Kim J, Park CY, et al. The effect of early canalith repositioning on
benign paroxysmal positional vertigo on recurrence. Clin Exp Otorhinolaryngol.
2011 Sep;4(3):113-7.Ramakrishna J, Goebel JA, Parnes LS. Efficacy and safety
of bilateral posterior canal occlusion in patients with refractory benign
paroxysmal positional vertigo: case report series. Otol Neurotol. 2012
Jun;33(4):640-2.
Foster CA, Zaccaro K, Strong D. Canal conversion and reentry: a risk of DixHallpike during canalith repositioning procedures. Otol Neurotol. 2012
Feb;33(2):199-203.
Guo X, Wang Q, Li Y, et al. A pre- and post-treatment study of quality of life in
patients with benign paroxysmal positional vertigo. Lin Chung Er Bi Yan Hou Tou
Jing Wai Ke Za Zhi. 2011 Aug;25(16):729-31.
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