Benign paroxysmal positional vertigo - Emerging treatments

DizzyFIX

The DizzyFIX is a visual analogue device designed to assist in the home treatment of benign paroxysmal positional vertigo (BPPV). It is composed of a fluid-filled tube within which there is a small free-floating ball (simulating the canaliths), which attaches to the peak of a custom-made baseball cap or peaked cap, placing it directly in the patient's visual field at all times. The device is used to guide patients through the steps of the particle repositioning manoeuvre (PRM). The patient attempts to move the particle from one end of the tubing to the opposite end. Essentially, the only way to do so is by performing a proper PRM. The adverse effects and contraindications to its use are similar to those of the repositioning manoeuvres. Some individuals should not use the DizzyFIX at home without appropriate supervision: these include older people, individuals with mobility issues, those with neck problems, and those at high risk for a stroke. The device is especially useful for recurrences. If the DizzyFIX fails, then repositioning manoeuvres should be attempted by a physician. There is one article assessing its efficacy in print.[64] A small randomised controlled study has demonstrated that DizzyFIX users are significantly more likely to perform the PRM correctly.[64] One multicentre prospective cohort study has demonstrated that at 1 week post-DizzyFIX use, 88% of patients experienced remission of their BPPV upon Dix-Hallpike testing.[92]

Epley Omniax

The Epley Omniax is a highly manoeuvrable computerised patient-positioning apparatus used for the diagnosis and treatment of BPPV.[75] It incorporates software with real-time constant electronic monitoring of nystagmus and semicircular canal spatial orientation. The patient is strapped into a chair that sits at the centre of the apparatus, and can then be positioned very precisely by a computerised, motor-driven frame that surrounds and is attached to the chair. The apparatus is capable of positioning a patient in any position, including a full 360° rotation in any of the semicircular canal planes and head inversions, as well as having the ability to oscillate between positions if necessary. As the patient is completely restrained within the device and the head position is fixed against a headrest, the Epley Omniax is especially useful for individuals with contra-indications to repositioning manoeuvres that require neck movements, such as patients with cervical spine or other issues that limit neck extension, high-grade carotid stenosis, and suspected vertebrobasilar disease. Other indications for its use include atypical forms of BPPV, including lateral (horizontal) and anterior (superior) canal variants, and patients resistant to other treatment approaches. One retrospective study found a 98% short-term cure rate of BPPV after multiple treatments with the Epley Omniax.[75] Randomised studies are under way at multiple sites across the US, and this product has received US Food and Drug Administration clearance.

Vitamin D status

There is some research to suggest that Vitamin D deficiency might correlate to occurrence and recurrence of idiopathic BPPV, and that its correction might improve outcomes.[93][94][95] Further studies are necessary.