MASTOID OSCILLATION - A CRITICAL FACTOR FOR SUCCESS IN THE CANALITH REPOSITIONING PROCEDURE

The canalith repositioning procedure has recently gained controversial recognition as a treatment for benign paroxysmal positional vertigo. Some authors contend that the canalith repositioning maneuver is no mo re effective than no treatment at all. Unfortunately, its technique ha s not been uniformly applied and its outcomes have not been uniformly assessed. I have found the use of mastoid oscillation to be critical i n the success of this procedure. Another important factor is the time interval between diagnosis and relief of symptoms. Because if is well known that benign paroxysmal positional vertigo can spontaneously reso lve after many months, the time frame for comparison should be short. A 1-week time interval was chosen for study purposes. Sixty patients w ere randomly assigned to three initial groups. The control group (n = 23) was not given any treatment. A second group (n = 27) was given tre atment with the canalith repositioning maneuver with mastoid vibration . A third group (n 10) was assigned to receive the canalith reposition ing maneuver without mastoid vibration. Resolution was defined as no s ymptoms and negative Dix-Hallpike test results. The results showed tha t none of the control group's symptoms resolved completely in 1 week. Although 60% of those who received the canalith repositioning maneuver without mastoid vibration felt improved, none was free of nystagmus. An overwhelming 92% of those who received the canalith repositioning m aneuver with mastoid vibration felt improved, and 70% were free of rot atory nystagmus after only one treatment. A review of all patients dia gnosed with benign paroxysmal positional vertigo and treated with the canalith repositioning maneuver with mastoid vibration was also undert aken. In a series of 67 patients with a minimum of four weeks of follo w-up, only two have not responded to the canalith repositioning maneuv er, yielding a 97% rate of symptom control.