Manobras de reposição otolítica associadas à fisioterapia vestibular em pacientes com vertigem posicional paroxística benigna

Abstract

Introduction: Benign Paroxysmal Positional Vertigo (BPPV) is a peripheral vestibular dysfunction characterized by episodes of vertigo triggered by head movements. The standard treatment for this condition is the Canalith Repositioning Maneuver (CRM), and although this procedure is effective in treating BPPV in most cases, some individuals may continue to experience dizziness and imbalance for several weeks after the maneuver. Therefore, vestibular physiotherapy (VP) exercises may be recommended to help reduce residual symptoms. Objective: To evaluate the impact of Canalith Repositioning Maneuvers (CRM) combined with individualized Vestibular Rehabilitation Therapy (VRT) exercises in patients with Benign Paroxysmal Positional Vertigo (BPPV). Methods: This is a retrospective descriptive study, approved by the Human Research Ethics Committee of UFRN under opinion number 3.949.007 (CAAE: 12098019.4.0000.5537). The participants included 16 individuals, on average 58 years old, who had been clinically diagnosed with BPPV and came from the university extension project “Reabilitação vestibular em pacientes com disfunções otoneurológicas”, conducted at the Physiotherapy Department of the Universidade Federal do Rio Grande do Norte (UFRN). The diagnosis of BPPV and identification of the affected canal were determined through the Dix-Hallpike and Supine Roll Test. Symptom intensity was quantified using the Numerical Rating Scale (NRS); static balance was assessed by the modified Clinical Test of Sensory Interaction and Balance (mCTSIB); dynamic balance and gait were evaluated using the Dynamic Gait Index (DGI); and quality of life was measured by the Dizziness Handicap Inventory (DHI). The participants underwent an intervention protocol including the Canalith Repositioning Maneuver (CRM) followed by individualized vestibular physiotherapy (VP) exercises. Results: The study included 16 individuals, mostly women (100%), with an average age of 58 years (± 10.6). All the individuals who underwent ORM had remission of vertigo; however, 12 reported episodes of dizziness and/or imbalance after the maneuvers. As a followup, vestibular physiotherapy (VP) exercises were implemented, with an average of 6.25 sessions per participant. After the intervention, there was a significant reduction in the intensity of vertigo, an improvement in dynamic balance during walking and a reduction in the impact of dizziness and vertigo on quality of life. Conclusion: The study demonstrated that the combined protocol of ORM with Vestibular Physiotherapy exercises in individuals with BPPV was effective in decreasing the symptoms of dizziness, vertigo and postural instability, as well as improving quality of life.