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Original Article
April 2004

Persistent Vertigo Following Particle Repositioning Maneuvers: An Analysis of Causes

Author Affiliations

From the Department of Ear, Nose, and Throat/Speech and Hearing, Christian Medical College and Hospital, Vellore, India. Dr Rupa is currently at Alice Springs Hospital, Alice Springs, Australia. The author has no relevant financial interest in this article.

Arch Otolaryngol Head Neck Surg. 2004;130(4):436-439. doi:10.1001/archotol.130.4.436

Objective  To analyze the causes of persistent vertigo following treatment with particle repositioning maneuvers (PRMs) in patients with benign paroxysmal positional vertigo.

Design  Prospective study of outcomes in patients with benign paroxysmal positional vertigo.

Study Setting  Outpatient clinic of a tertiary care referral center.

Patients  A sample of 90 consecutive patients with documented benign paroxysmal positional vertigo of the posterior semicircular canal who had persistent vertigo after at least 3 sessions of PRMs during a period of 2 weeks.

Intervention  Particle repositioning using a modified Epley maneuver.

Main Outcome Measure  Persistent vertigo following at least 3 sessions of PRMs over a period of 2 weeks.

Results  Seven patients showed partial or no improvement following treatment. The causes subsequently determined included coincident horizontal canal positional vertigo (2 cases), Ménière's disease (2 cases), persistent posterior canal benign paroxysmal positional vertigo in association with cervical spondylosis (2 cases), and a posterior fossa meningioma (1 case).

Conclusions  Patients with persistent or frequently recurring positional vertigo following treatment with PRMs should undergo detailed investigation to exclude coincidental pathology for which specific treatment is required. In patients in whom no coincident pathology requiring therapy is identified, treatment options other than the PRM already instituted should be considered.