Head trauma with or without concussion is a well-known cause of BPPV in both children and adults. More importantly, BPPV secondary to head trauma has been associated with increased bilateral and multiple canal involvement as well as a higher recurrence rate.

The benefit of the GRM and Semont Liberatory Maneuver (SLM) when treating bilateral cases, they use only 2 side-lying positions, so that the contralateral involved ear is not “triggered” or activated when the patient is placed in the second or final position. This is different than an Epley style treatment, which uses 3 positions, and will trigger vertigo when the patient’s head is moved into the 2nd position. The GRM has been well documented to be highly effective with or without post treatment restrictions. The AIB rarely restricts patients post-treatment based on the abundant scientific literature and clinical experience suggesting it is unnecessary.

CASE STUDY: 81 y.o.m. Post head trauma with concussion. He fell while walking his dog and was entangled in the leash. Following medical examination and CT scan, patient was referred to AIB for complaint of positional vertigo. Testing indicated a bilateral PC-BPPV, stronger in the right ear. Protocol was as follows:

1. Treat right ear
2. Recheck and retreat right ear
3. Treat left ear
4. Recheck and retreat left ear
5. Check lateral body position to ensure there has been no HC migration
6. See patient in approximately 5-7 days for follow-up

All treatment outlined above is accomplished in the one treatment visit. The recheck and retreatments are conducted regardless if the patient is clear on the recheck. AIB’s success rate has increased from 80 to 97% in the one treatment visit since this protocol has been initiated over the past 7 years.

References:

1. Badawy et al., (2015), Effect of a Hybrid Maneuver in Treating Posterior Canal Benign Paroxysmal Positional Vertigo, J. Am. Acad. Audiol, 26:138-144
2. Dispenza, et al., (2012), Comparison of repositioning maneuvers for benign paroxysmal positional vertigo of semicircular canal: advantages of hybrid maneuver, Am. J. of Otolaryngology, 528-532
3. Roberts RA, Gans RE and Montaudo RL, (2006), Efficacy of a new treatment maneuver for posterior canal benign paroxysmal positional vertigo, J Am Acad Audiol, 17:598-604
4. Roberts RA, Gans RE, DeBoodt JL, Lister JJ, (2005), Treatment of benign paroxysmal positional vertigo: necessity of postmanuever restrictions. J Am Acad Audiol 17(8): 598-604