To evaluate the efficacy of the Santiago treatment protocol for benign paroxysmal positional vertigo of the posterior semicircular canal, to analyse recurrence and to establish prognostic factors.

Four hundred and twelve patients with unilateral benign paroxysmal positional vertigo of the posterior semicircular canal were treated with the Semont manoeuvre and, if symptoms did not resolve, successive application of three Epley manoeuvres plus Brandt–Daroff exercises.

Symptoms resolved in 404 patients (98.1 per cent); a single Semont manoeuvre was sufficient in 334 (81.2 per cent). Aetiology had no impact on resolution of symptoms or number of manoeuvres required. The estimated likelihood of recurrence was 14 per cent in the first year and 27 per cent after 10 years. The only factor indicating a worse prognosis was recurrence.

In unilateral benign paroxysmal positional vertigo of the posterior semicircular canal, the above treatment protocol cured 98 per cent of patients. More than half of recurrences occurred in the first year. None of the analysed factors increased the likelihood of recurrence.

Benign paroxysmal positional vertigo is one of the commonest peripheral vestibular causes of vertigo. The particle repositioning manoeuvre (Epley's manoeuvre) has become the ‘gold standard’ treatment for this disorder. Benign paroxysmal positional vertigo can affect any age group but is commoner in older patients. Cervical spine problems (e.g. spondylosis and disc prolapse) are commoner in this age group. Epley's manoeuvre necessitates passive neck movements. Such movements may not be wise in patients at risk of cervical spine fracture.

This study included 40 patients complaining of vertigo and diagnosed as having benign paroxysmal positional vertigo. A new particle repositioning manoeuvre was designed for these patients, as an alternative to Epley's manoeuvre.

At one week review, 36 patients (90 per cent) reported total relief from vertigo. Three patients reported a major improvement in their vertigo, and their residual vertigo was relieved by performing the new manoeuvre again after two weeks. Further clinical reviews at one month, three months, six months and one year found that seven patients had suffered minor attacks of typical benign paroxysmal positional vertigo after three months. All seven were relieved of their symptoms after undergoing the new particle repositioning manoeuvre again.

The proposed new manoeuvre is simple, effective and safe for treating patients with benign paroxysmal positional vertigo and cervical spine problems.

We describe a case of benign paroxysmal positional vertigo which occurred after use of a whole-body vibration training plate.

Case report and literature review concerning the secondary causes of benign paroxysmal positional vertigo and the physiological effects of whole-body vibration training plates.

A 44-year-old woman was referred with classic symptoms of benign paroxysmal positional vertigo following use of a whole-body vibration training plate, a popular form of fitness equipment widely used in sports, rehabilitation and beauty treatments. The condition resolved spontaneously after several days. There have been reports of negative side effects in users of this equipment, such as dizziness, headache and a sensation of imbalance; however, there have been no reported cases involving vertigo. Based on a literature review, this equipment may cause side effects, including vertigo, by generating forces that can increase the original amplitude of internal organs, which may potentially cause labyrinthine trauma or dislocation of otoconia, leading to benign paroxysmal positional vertigo.

We suggest that whole-body vibration training plates may potentially induce benign paroxysmal positional vertigo. Manufacturers may need to make users of this equipment aware of this risk, and remind them to use it with caution.

To determine the degree of association, if any, between benign paroxysmal positional vertigo and osteoporosis, both of which are disorders of impaired calcium carbonate homeostasis.

A retrospective chart review was undertaken in two otology clinics to assess the prevalence of treated osteoporosis in 260 women with and without benign paroxysmal positional vertigo, between the ages of 51 and 80 years.

There was a statistically significant, negative association between benign paroxysmal positional vertigo and treated osteoporosis in women aged 51 to 60 years. We also observed a trend towards a negative association for women in their 60s, and for the group as a whole.

Osteoporosis, or the medication used to treat it, may provide protection against benign paroxysmal positional vertigo.

Superior semicircular canal dehiscence affects the auditory and vestibular systems due to a partial defect in the canal's bony wall. In most cases, sound- and pressure-induced vertigo are present, and are sometimes accompanied by pulse-synchronous tinnitus.

We describe a 50-year-old man with superior semicircular canal dehiscence whose only complaints were head rotation induced tinnitus and autophony. Head rotation in the plane of the right semicircular canal with an angular velocity exceeding 600°/second repeatedly induced a ‘cricket’ sound in the patient's right ear. High resolution temporal bone computed tomography changes, and an elevated umbo velocity, supported the diagnosis of superior semicircular canal dehiscence.

In addition to pulse-synchronous or continuous tinnitus, head rotation induced tinnitus can be the only presenting symptom of superior semicircular canal dehiscence without vestibular complaints. We suggest that, in our patient, the bony defect of the superior semicircular canal (‘third window’) might have enhanced the flow of inner ear fluid, possibly producing tinnitus.

To highlight the possibility of internal carotid artery dissection following canalith repositioning procedures.

A 52-year-old woman with right posterior canal benign paroxysmal positional vertigo sustained a right carotid artery dissection following a canalith repositioning procedure. The patient also had profound mixed hearing loss associated with otosclerosis, so underwent simultaneous cochlear implantation and occlusion of her posterior semicircular canal, following completion of anticoagulation therapy for her dissection.

While internal carotid artery trauma is a rare adverse outcome following canalith repositioning procedures, clinicians should be aware of this possibility if patients report unusual symptoms following such procedures.

To assess the long-term efficacy of Epley's manoeuvre performed to treat benign paroxysmal positional vertigo.

Two hundred and sixty-nine patients suffering benign paroxysmal positional vertigo were offered Epley's manoeuvre. After five years, follow up was arranged. One hundred and three patients attended for follow up (58 women and 45 men; age range 19–65 years). As mentioned 269 patients were offered the EM and 103 of them were available for follow up. Prior to initial Epley's manoeuvre treatment, these patients' duration of benign paroxysmal positional vertigo had ranged from four to 96 weeks.

Five years after treatment of benign paroxysmal positional vertigo with Epley's manoeuvre, 65 per cent of patients reported no further attacks. Kaplan–Meier testing showed that the time to recurrence was significantly longer in patients aged less than 40 years, those with a duration of attacks of less than three years prior to initial Epley's manoeuvre treatment, and those suffering less than six exacerbations prior to initial Epley's manoeuvre treatment. Gender had no effect on time to recurrence. Duration of illness before receiving Epley's manoeuvre was the only independent predictor of recurrence.

Epley's manoeuvre remains an effective modality for treatment of benign paroxysmal positional vertigo. A patient age of less than 40 years and duration of attacks of less than three years are good prognostic factors. Exacerbation number and gender do not affect the probability of benign paroxysmal positional vertigo recurrence after five years; however, these factors do affect the duration of time free from the condition.

The aim of this study was to investigate the frequency of posterior semicircular canal benign paroxysmal positional vertigo in each ear, and to assess the association between the ear affected by benign paroxysmal positional vertigo and the head-lying side during sleep onset. Based on a previous study which used objective methods to prove the preference of the elderly for the right head-lying side during sleep, we hypothesised that a predominance of the same head-lying side in benign paroxysmal positional vertigo patients may affect the pathophysiology of otoconia displacement.

We conducted a prospective study of out-patients with posterior semicircular canal benign paroxysmal positional vertigo, confirmed by a positive Dix–Hallpike test.

One hundred and forty-two patients with posterior semicircular canal benign paroxysmal positional vertigo were interviewed about their past medical history, focusing on factors predisposing to benign paroxysmal positional vertigo. All patients included in the study were able to define a predominant, favourite head-lying side, right or left, during sleep onset.

The Dix–Hallpike test was found to be positive on the right side in 82 patients and positive on the left side in 54; six patients were found to be positive bilaterally. During sleep onset, 97 patients habitually laid their head on the right side and the remaining 45 laid their head on the left. The association between the affected ear and the head-lying side during sleep onset was statistically significant (p < 0.001).

Our study found a predominance of right-sided benign paroxysmal positional vertigo, a subjective preference amongst patients for a right head-lying position during sleep onset, and an association between the ear affected by benign paroxysmal positional vertigo and the preferred head-lying side during sleep onset. The clinical and therapeutical implications of this observation are discussed.