Is Self-Treatment of BPPV Effective as the First Line of Treatment?

Objective

pc-BPPV is a common, recurring cause of rotational vertigo which is often treated using an Epley manoeuvre (EP). These manoeuvres are typically performed by a clinician but can be self-performed. The aim of this study was to determine how effective self-treatment of pc-BPPV was as the first line of treatment during the COVID19 pandemic.

Design

From March 2020–March 2021, possible pc-BPPV patients were identified based on their symptom history alone and offered self-treatment via the modified EP (MEP). The proportions of patients whose symptoms resolved at ~1-week follow-up were retrospectively analysed and compared to those who received clinician-treatment from February 2019 – February 2020, the year prior to the introduction of this self-treatment service.

Sample

90 patients (aged 21-87) were identified as having possible pc-BPPV from March 2020 – March 2021 (self-treatment group). 80 patients (aged 21-90) with pc-BPPV, confirmed with a positive DH and treated by a clinician-performed EP, were seen from February 2019 – February 2020 (clinician-treatment group).

Results

56% of the self-treatment group accepted the offer of self-treatment, 8% declined, 30% had contraindications and 6% were not offered self-treatment. Of those that accepted self-treatment (n=50), just 58% reported attempting the manoeuvre at follow-up. Of those that attempted self-treatment (n=29), 48% reported their symptoms resolving at follow-up. In the clinician-treated group, 54% of patients reported symptoms completely resolving at follow-up. Logistic regression analysis revealed no significant difference in resolution of symptoms between groups (p=0.668).

Conclusions

Self-treatment of BPPV as the first line of treatment has a comparable efficacy to clinician-treatment. However, a large proportion of patients either declined self-treatment, did not adhere to self-treatment, or were contraindicated for self-treatment.