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Brandt-Daroff Exercises. Symptoms persisting one week require formal evaluation.
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Pittsburgh Ear’s positional vertigo treatment protocol was recently reviewed in study of 140 consecutive positional vertigo patients treated during calendar year 1999 with at least 6 months follow-up.
At PEA positional vertigo is diagnosed with the Hallpike maneuver with the patient wearing infra-red video goggles. If the appropriate nystagmus is confirmed patients are treated with the canalith repositioning maneuver with vibration on the mastoid cortex while eye movements are observed. Patients are asked to keep their heads upright for 48 hours and then resume normal activities. Patients are called by telephone in one week, if still symptomatic they begin Brandt-Daroff positional vertigo exercises three times daily.
In our study, (which has been submitted to the Archives of Otolaryngology) the success rate was greater than 90% with head maneuvers and exercises alone. For patients with recurrent symptoms or atypical findings close follow-up was necessary. Surgery is available for refractory cases. However, in some patients persistent positional vertigo is a sign of a more serious skull base neoplasm or neurotological disorder. For this reason, patients with persisting or unusual symptoms require complete vestibular and imaging evaluation.
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