Comparative Study Between Vestibular Maneuver Vs Vestibular Maneuver With Drug Therapy In Management Of Patients With Benign Paroxysmal Positional Vertigo

Abstract

Background:

Benign Paroxysmal Positional Vertigo (BPPV) is the most common peripheral vestibular disorder, characterized by brief vertigo episodes triggered by head position changes. It results from dislodged otoconia entering semicircular canals, primarily the posterior canal, disrupting normal vestibular function. The Epley maneuver, a repositioning technique, is a well-established treatment. However, pharmacological agents like betahistine are sometimes co-administered despite limited evidence for their added efficacy.

Objective:

To compare the clinical effectiveness of Epley maneuver alone versus Epley maneuver combined with oral betahistine in managing BPPV symptoms, particularly evaluating their impact on symptom resolution and functional disability.

Methods:

A hospital-based randomized trial was conducted over 19 months involving 122 patients aged 18–60 years, diagnosed with BPPV confirmed via Dix-Hallpike test. Patients were randomized into two groups:

• Group A (n=61): Treated with Epley maneuver only
• Group B (n=61): Treated with Epley maneuver + oral betahistine (48 mg/day for 1 week)

Outcomes were assessed at baseline, 1 week, 3 weeks, and 6 weeks using the Dizziness Handicap Inventory (DHI), Visual Vertigo Analogue Scale (VVAS), and Mean Vertigo Score (MVS). The primary endpoint was reduction in DHI scores over time.

Results:

Demographic and clinical parameters (age, sex distribution, symptom duration, and precipitating factors) were comparable across groups (p > 0.05). Both groups showed improvement in DHI scores post-treatment; however:

• At 3 weeks and 6 weeks, Group A (maneuver-only) showed significantly greater improvement in DHI scores compared to Group B (combined therapy) (p < 0.001).
• Generalized Estimating Equation (GEE) analysis confirmed that symptom improvement over time was statistically significant (p < 0.001), with the maneuver-only group showing better results (p = 0.031).
• At baseline and week 1, no statistically significant difference was found between groups.

Conclusion:

Epley maneuver alone is not only effective but superior to combined therapy with betahistine in managing BPPV, offering faster and more sustained symptom relief. This supports its role as the first-line and standalone treatment in BPPV management. The study discourages routine use of pharmacological agents like betahistine due to lack of added benefit, aligning with principles of evidence-based and cost-effective care.

Limitations:

The study had a limited sample size and short follow-up duration (6 weeks). Absence of a placebo-controlled group for the drug therapy arm limits conclusive interpretation regarding betahistine’s independent efficacy.