Canalith repositioning maneuvers prefered treatment for benign paroxysmal positional vertigo

The study showed that vestibular suppressants do not impact symptom resolution at the point of the most extended follow-up in patients with benign paroxysmal positional vertigo; however, there is evidence that CRMs are superior over these medications. Vestibular suppressants have an uncertain impact on repeat ED/clinic visits, symptom resolution within 24 h, quality of life, patient satisfaction, and adverse events.

Benign paroxysmal positional vertigo is a frequent cause of acute dizziness. Medication use for its treatment is common despite guidelines recommending against their use. Sameer Sharif from McMaster University in Hamilton, Ontario, Canada, and colleagues, therefore, aimed to evaluate the safety and efficacy of vestibular suppressants in BPPV patients compared to placebo, CRMs, or no treatment.

For this purpose, the researchers searched the online databases from inception until March 25, 2022. for RCTs (randomized controlled trials) comparing phenothiazines, antihistamines, benzodiazepines, and anticholinergics compared to no treatment, placebo, or a CRM. In the quantitative analysis, five RCTs comprising 296 patients, were included.

The study led to the following findings:

• The authors found that vestibular suppressants may not affect symptom resolution at the point of most extended follow-up (14–31 days in four studies) when assessed as a continuous outcome (standardized mean difference –0.03 points).
• At the longest follow-up point, CRMs may improve symptom resolution as a dichotomous outcome compared to vestibular suppressants (relative risk [RR] 0.63).
• Vestibular suppressants had an undetermined effect on symptom resolution within 24 h (mean difference [MD] 5 points), patient satisfaction (MD 0 points), repeat emergency department (ED)/clinic visits (RR 0.37), and quality of life (MD −1.2 points).
• Vestibular suppressants had an uncertain effect on adverse events.

"In benign paroxysmal positional vertigo patients, vestibular suppressants do not impact symptom resolution at the point of longest follow-up; however, there is evidence towards CRM superiority over these medications," the authors wrote. "There is an uncertain effect of vestibular suppressants on repeat ED/clinic visits, symptom resolution within 24 h, adverse events, and quality of life."

"These data indicate that a CRM, not vestibular suppressants, should be the primary treatment for patients with BPPV," they concluded.

Reference:

Sharif S, Khoujah D, Greer A, Naples JG, Upadhye S, Edlow JA. Vestibular suppressants for benign paroxysmal positional vertigo: A systematic review and meta-analysis of randomized controlled trials. Acad Emerg Med. 2022 October 21. doi: 10.1111/acem.14608. Epub ahead of print. PMID: 36268806.