Systematic Review of Bilateral Benign Paroxysmal Positional Vertigo

OBJECTIVES: To evaluate the success rates of canalith repositioning maneuvers (CRM) in the treatment of patients diagnosed with bilateral benign paroxysmal positional vertigo (BiBPPV). STUDY DESIGN: Systematic review. METHODS: A comprehensive search of only English studies in PubMed, Ovid (1946 to the present), and Embase (1974 to the present) databases was done up until January 1, 2021. Studies that diagnosed patients with BiBPPV specifically and evaluated the CRM success from all published years were included. Studies were excluded if follow-up was less than 6 months or if they failed to distinguish BiBPPV from ipsilateral multi-canal BPPV. A total of nine studies were included with a total study population of 325 patients. Included studies were evaluated for bias with the National Institutes of Health (NIH) Study Quality Assessment Tool. Success rates of CRM, number of treatments required, and disease recurrence rates were extracted. RESULTS: The overall success rate was compiled using a fixed-effect binary inverse variance model and was 95.2% (CI: 92.9%-97.5%). A qualitative review suggested treating the more affected side first on separate visits until resolved, followed by contralateral treatment (recommendation). The mean number of treatments was 2.9 (CI: 2.4-3.4), and the recurrence rate was 19.8% (CI: 11.7%-27.9%). There was a higher proportion of trauma etiology of BiBPPV compared to unilateral, with an odds ratio of 8.9 (CI: 5.1-15.3). CONCLUSIONS: Overall, this meta-analysis shows high success rates for CRM in the treatment of BiBPPV. Rates are similar to CRM efficacy for unilateral BPPV. Laryngoscope, 132:640-647, 2022.