1. Rosenberg, Karen


According to this study:


* A randomized clinical trial demonstrated the efficacy of a web-guided self-treatment system for recurrent benign paroxysmal positional vertigo.


* This system can play an important role in telemedicine for vestibular disorders.



Article Content

The canalith repositioning maneuver (CRM) effectively treats benign paroxysmal positional vertigo (BPPV), a common and recurrent disorder. A randomized, double-blind clinical trial was designed to determine the therapeutic efficacy of web-guided self-administration of CRM for recurrent BPPV.


Patients ages 20 years and older who had been diagnosed with and treated for BPPV were randomized to the treatment or control group. Participants were instructed to access an interactive web-response system using a computer or smartphone when they experienced recurrent BPPV. Patients in the treatment group completed a web-based questionnaire and then received a video clip for self-application of the CRM designed specifically for their subtype of BPPV as determined by the questionnaire. Those in the control group received a video clip for the subtype of BPPV that had been diagnosed and treated at the time of their enrollment in the study.


Of the 585 enrolled patients, 128 (21.9%) experienced recurrence of BPPV, and 109 of these (85.2%) used the web-based system successfully. In the intention-to-treat analysis, 42 of 58 patients (72.4%) in the treatment group and 30 of 70 patients (42.9%) in the control group reported vertigo resolution after application of the web-based system. In the per-protocol analysis, 42 of 51 patients (82.4%) in the treatment group and 30 of 58 patients (51.7%) in the control group had vertigo resolution.


Patients reported no difficulty using the web-based system, and most could use it by themselves. None of the patients who used this system reported serious adverse events.


Among the limitations of the study were that it included only patients who had confirmed and treated BPPV. Furthermore, the web-based system could only be applied to patients who could access the internet and use a computer or smart devices, which could limit its use in older adults who have cognitive impairment.


The authors suggest that the web-based system could be used in primary care and for those who have vestibular disorders other than BPPV.


Kim HJ, et al JAMA Neurol 2023;80(3):244-50.