Author(s)
Suwicha Kaewsiri Isaradisaikul, MD
Sanathorn Chowsilpa, MD
Charuk Hanprasertpong, MD
Tayaporn Rithirangsriroj, MD
Affiliation(s)
Otology, Neurotology and Communication Disorder Unit,
Department of Otolaryngology, Faculty of Medicine, Chiang Mai University 110 Intawaroros Road, Sriphum, Meuang, Chiang Mai, 50200. Thailand;
Abstract:
Objective: To compare the treatment outcomes and complications of single versus multiple cycles of canalith repositioning
procedure (CRP) for unilateral posterior canal benign paroxysmal positional vertigo (PSC BPPV).
Study Design: Randomized controlled trial.
Setting: Tertiary academic center.
Patients: 143 PSC BPPV adults with unilateral positive Dix-Hallpike test (DHT)
Interventions: Single versus multiple cycles of CRP.
Main Outcome Measures: Rate of negative DHT, symptom improvement, complications, and dizziness handicap
inventory score (DHI) after CRP at day 0, 7 and 28.
Results: Between single cycle and multiple cycle groups; patients’ characteristics included age (57.1 and 55.0 years), female
to male ratio (2.35:1 and 2.64:1), numbers of vertigo attacks per day (2 and 2.5), affected ear (right vs. left; 1:1.2 and 1:1.2),
DHI scores showed no difference. After CRP at day 7 and 28: 1) Rate of negative DHT (82.5% and 84.3%; p-value = 0.71,
89.5% and 88.9%; p-value = 0.84); 2) Rate of complete recovery or improved symptoms (96.5% and 92%; p-value = 0.37,
96.5% and 98.0% 0.62); 3) DHI grading scale (p-value = 0.08 and 1.0) between single cycle and multiple cycle groups
showed no significant difference. Rate of complications in the single cycle group, day 0, (93.1%) was lower than in multiple
cycle groups (78.9%); p-value = 0.014, power of test = 98.9%).
Conclusions: Single cycle of CRP is as effective as multiple cycle CRP, with a lower complication rate and decreased time
for treatment. Single cycle CRP is a preferable treatment for unilateral PSC BPPV.
Define Professional Practice Gap & Educational Need: 1. CRP is a treatment of choice for PSC BPPV; variation of CRP technique has been reported. 2. Improvement of CRP technique with excellent treatment outcomes to maximize patient comfort should be investigated.
Learning Objective: 1. To confirm the effectiveness of this new technique of CRP and its complications. 2. Better CRP
treatment techniques should improve patient care and shorten the physician’s time while implementing CRP treatment.
Desired Result: 1. Consider the use of single cycle CRP to treat PSC BPPV. 2. Initiate other treatment outcomes, long term
results and further studies to confirm the use of single cycle CRP
Level of Evidence - Level I Large RCTs with clear cut results.
Indicate IRB or IACUC: : Approved, research ID: 3601; Chiang Mai University Hospital.