Specific Management
Specific management options exist for several causes of vertigo.
Benign paroxysmal positional vertigo (BPPV)
Canalith repositioning manoeuvres have been used in an attempt to move canaliths out of the semicircular canal to treat BPPV.
The Epley manoeuvre is used to treat BPPV due to posterior canal canaliths (>90% of cases of BPPV) and has been shown to be safe, and effective, at least in the short term. It can be used in the ED. However, recurrence rates may be as high as 50% over 5 years, although the manoeuvre can be repeated or even taught.
Anterior canal BPPV is rare, and can be a complication of canalith repositioning manoeuvres because the canaliths migrate from the posterior canal into the anterior canal. Such cases may respond to other specialist manoeuvres.
The Epley (canalith repositioning) manoeuvre
Other Management
Vestibular neuritis
There is evidence that methylprednisolone given acutely may improve longer-term vestibular function in patients with presumed viral vestibular neuritis,17 though the editor is not aware of this treatment being widely used.