Residual postural instability in benign paroxysmal positional vertigo

Introduction: Patients with benign paroxysmal positional vertigo (BPPV) often experience postural instability as well as brief episodes of vertigo. Objective: To assess the effect of a canalith repositioning manoeuvre (CRM) on the improvement in postural instability in patients with idiopathic BPPV and to find factors that would predict this improvement. Methods: Nineteen patients with a diagnosis of BPPV of canalithiasis pathology participated in this study. After diagnosis, all patients were treated by CRM. Postural stability was assessed by a Sensory Organization Test (SOT) with six sensory conditions before and one week after successful CRM. Results: CRM improved postural instability in 36.8% (7/19) of patients. There was a statistically significant difference between pre- and post-repositioning SOT 4, 5, 6 and the composite score (CS). Compared to the control age-matched normative values, there was a statistically significant difference at SOT 4, 5, 6 and CS pre-repositioning and only a statistically significant difference at SOT 6 post-repositioning. Individually, some patients still had abnormal SOT scores. Residual imbalance was reported in about two-thirds of our series of patients (12/19) after successful CRM. Patients with right-sided BPPV significantly improved their SOT scores after repositioning, while females reported more residual imbalance. Conclusions: Successful CRM improved significantly postural instability in BPPV, but not in all patients. Better postural stability was encountered after CRM in patients with right-sided BPPV, which may be attributed to being the more commonly affected side or due to a more severe lesion.