Skip to main content

2012 Annual Conference

October 25–28, 2012

Henry B. Gonzalez Convention Center, San Antonio, TX

2012 TPTA Poster Abstracts

Single Session Treatment of Bilateral Benign Paroxysmal Positional Vertigo

Saturday, October 27, 2012 at 1:00 PM–2:00 PM CDT
Bulletin Board 12A
Presenter's Name - Last Name First

Chara Booker Rodriguez, PT, DPT, NCS

Presenter's Affiliation, City, State

University Hospital System, San Antonio, TX


The purpose of this case series report is to describe the treatment of bilateral benign paroxysmal positional vertigo (BPPV) in one treatment session. Another focus is to examine the efficacy rate of this treatment, recurrence rate of vertigo and any comorbid conditions present in 61 cases over a 10-year time frame (2002-2012). 


The charts of 61 subjects (47 female, 14 male) diagnosed with bilateral BPPV with ages ranging from 10 to 89 years old and a mean age of 64 years old were reviewed for this study.


In this retrospective case series we reviewed the charts of 61 patients diagnosed by a physician with bilateral BPPV using the Dix-Hallpike maneuver and who were referred for physical therapy evaluation and treatment with an appropriate canalith repositioning maneuver (CRM) in an outpatient physical therapy clinic.  Treatment included the administration of an appropriate CRM for BPPV for the patient-identified side with the most symptoms.  The patients were asked to sit in an upright position with the head and neck in a neutral, upright position for 15 minutes.  After this period of immobility, a second CRM was administered for the remaining side.  The patient was instructed in a home exercise program consisting of the Brandt-Daroff exercises to perform as needed. The patient’s medical charts were reviewed to collect the following data: patient age at time of the bilateral BPPV treatment, gender, the current status of BPPV (resolved or not), a check for any reoccurrence of BPPV over the 10-year time frame and any other comorbidities that the study cases may have concurrent to BPPV involvement.


In this review of bilateral BPPV several important points were identified. The majority of the cases reviewed were female, slightly more than 3:1. The majority of patients (56 or 92%) showed resolution of symptoms in the follow up visit with the physician. Some comorbidities were seen repeatedly in patients with bilateral BPPV including: endolymphatic hydrops or Meniere’s disease, allergic rhinitis, migraine, diabetes mellitus, head trauma, brain tumor, sinusitis and vestibular neuritis.


The efficacy of bilateral BPPV involvement treatment in one physical therapy session (92%) seen in this study suggests that bilateral and unilateral symptoms can be resolved at similar rates. The higher comorbidity prevalence in Meniere’s disease and migraine than the general population seen in this study could support the idea that certain patient medical comorbidities may affect BPPV onset risk.

Clinical Relevance

The higher recurrence rate in bilateral BPPV (46%) vs. unilateral BPPV (10-30%) affects the physical therapy treatment of bilateral BPPV. After CRM administration it is important clinically to address potential BPPV recurrence by teaching a home exercise program to the patient in order to allow for self-treatment.  Attention must be given also to providing patient education regarding the possibility of recurrence and establishing a potential action plan. Keywords:   BPPV, comorbidity, CRM


Dr Brian P Perry, MD, FACS, Ear Medical Group