Effectiveness of Canalith Repositioning Manoeuvres in the Management of Benign Paroxysmal Positional Vertigo: A Longitudinal Study Among Patients With Vestibular Disorders at a Tertiary Hospital in Tanzania

Abstract

Background: Previous studies have shown that canalith repositioning manoeuvres (CRM), such as Epley’s manoeuvre, offer adequate treatment for Benign Paroxysmal Positional Vertigo (BPPV) with a success rate of over 90% after a single treatment session. Benign Paroxysmal Positional Vertigo (BPPV) is one of the otological disorders encountered during routine otorhinolaryngology practice in the study area. Data on the effectiveness of CRM in the management of BPPV in Tanzania remain extremely scarce. This study aimed to determine the proportion of BPPV and the effectiveness of CRM among patients with vestibular disorders at Muhimbili National Hospital in Tanzania.
Methods: A hospital-based longitudinal study was conducted from October 2022 to March 2023 at a vestibular clinic of Muhimbili National Hospital, Tanzania. The study included 133 male and female patients with vestibular disorders such as dizziness, vertigo, and/or imbalance. Patients underwent initial Dix-Hallpike and Supine head roll tests, with results recorded, including the site and side of the semicircular canal (SCC) involved for BPPV, followed by the performance of CRM. A one-week follow-up assessed the conversion from a positive to a negative BPPV test. For those whose tests remained positive, weekly re-evaluations and additional CRM sessions were conducted until a negative conversion was achieved. The data collected was analysed using the Statistical Package for the Social Sciences Version 25.0.
Results: A total of 133 patients were recruited and 29 (21.8%) were diagnosed with BPPV. The most affected age group was 67-86 years, 11 (36.7%), with a mean age of 55.14±17.7 years. The proportion of BPPV was higher in females, 23 (27.1%), than in males, 6 (12.5%), (M: F ratio of 1:3.8). Majority of patients, 27 (93.2%) had Posterior SCC BPPV (16 had Right Posterior SCC BPPV and 11 had Left Posterior SCC BPPV), followed by 2 (6.8%) having Horizontal SCC BPPV (One patient with Right and one with Left Horizontal SCC BPPV) However, no one was found to have Anterior SCC BPPV. The majority of BPPV-positive patients, 24 (82.8%), converted to a negative BPPV test after the first CRM, and a few required up to a fourth CRM.
Conclusion: Benign Paroxysmal Positional Vertigo is one of the most common diagnoses among patients with vestibular disorders in our setting. It is characterised by vertigo and nystagmus caused by inertia of the otoconia in the semicircular canals and diagnosed by Dix-Hallpike and supine head roll tests. In this study, CRM has shown significant effectiveness in BPPV treatment. Therefore, healthcare providers should be aware that most patients require only one manoeuvre; however, follow-up remains essential as some may need up to four manoeuvres to achieve full recovery.
Keywords: Vertigo, Benign paroxysmal positional vertigo, Canalith repositioning manoeuvre, Vestibular Disorder, Dix-Hallpike test, Tanzania