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The Canalith Repositioning Procedure for Benign Positional Vertigo: A Meta‐Analysis
Author(s) -
Woodworth Bradford Alan,
Gillespie M. Boyd,
Lambert Paul R.
Publication year - 2004
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1097/00005537-200407000-00002
Subject(s) - benign paroxysmal positional vertigo , medicine , confidence interval , odds ratio , meta analysis , randomized controlled trial , vertigo , pediatrics , surgery
Objective: To review the effectiveness of the canalith repositioning procedure (CRP) in the treatment of benign paroxysmal positional vertigo (BPPV) with a critical review of the literature and meta‐analysis. Study Design: Meta‐analysis. Methods: Studies eligible for inclusion were randomized, controlled trials of the CRP performed on clearly defined cases of BPPV. A total of nine studies meeting inclusion criteria were identified by two independent literature searches of Medline. Treatment and control groups were compared for symptom resolution and elimination of a positive Dix‐Hallpike test. Results: Patients treated with CRP were more likely to demonstrate symptom resolution (odds ratio [OR] 4.6; 95% confidence interval [CI] 2.8–7.6) and negative Dix‐Hallpike (OR 5.2; 95% CI 3.0–8.8) at the time of first follow‐up. The effect of CRP for symptom improvement was strongest within the first month after treatment (OR 4.1; 95% CI 3.1–5.2) with some decline thereafter (OR 2.8; 95% CI 1.7–3.9). Conversely, the ability of CRP to produce a negative Dix‐Hallpike strengthened between the first month after treatment (OR 3.0; 95% CI 1.8–4.0) and later follow‐up times (OR 5.0; 95% CI 3.9–6.1). Conclusions: The CRP is more effective than control in resolving vertigo and positive Dix‐Hallpike associated with BPPV. This finding was consistent among a variety of studies using different study designs. Untreated patients may demonstrate symptom improvement with time; however, many will continue to have a positive Dix‐Hallpike when examined. Resolution of vertigo in untreated patients is therefore most likely because of avoidance of provocative positions.