Treatment for benign positional vertigo

BMJ 1996;312:54 (6 January)

Letters

Treatment for benign positional vertigo

EDITOR,--In their review on benign positional vertigo ThomasLempert and colleagues place great faith in the histologicalfinding of particulate matter in the posterior semicircularcanal,¹ although there is a paucity of evidence that such particlesare directly implicated in benign positional vertigo. Schuknecht'soriginal observation was based on two postmortem studies.² Hethen went on to describe similar findings in 149 temporal bonesfrom 245 subjects without historical evidence of the disorder.³Furthermore, in this study the same abnormality was found inall three semicircular canals. Most recently, particulate matterhas been described in a majority of labyrinths examined, regardlessof symptoms.⁴ The theory of canalolithiasis therefore remainsplausible only in the absence of any other explanation.

It is wrong to base an entire therapeutic approach on a findingthat seems to be common in asymptomatic subjects or may be anartefact. In addition, Epley's manoeuvre as described has . . . [Full text of this article]

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