- Design
- Prospective randomised open-label trial, 12-month follow-up
- Population
- 102 patients with uncomplicated BPPV (89 completed)
- Primary outcome
- Manoeuvres to resolution, recurrence, DHI and VAS
- Effect
- Manoeuvres 2.25 vs 1.82 (p = 0.19); DHI improved similarly in both arms
A randomised, open-label study published in June 2026 assigned 102 patients with uncomplicated benign paroxysmal positional vertigo to repositioning on a mechanical rotational chair or to manual manoeuvres, with 12 months of follow-up; 89 completed it.
The number of manoeuvres needed did not differ (2.25 vs 1.82). Dizziness Handicap Inventory scores fell substantially in both groups (from 47 to 11 with the chair and 41 to 12 manually), with no difference between them. Older age and head trauma predicted more manoeuvres, and osteoporosis and earlier episodes predicted recurrence. Patients over 65 showed a trend towards faster resolution on the chair.
The study was small and open-label, but the message is consistent with practice: manual repositioning works well, and expensive equipment adds little for uncomplicated cases.
Chairs may help where neck or back problems, obesity or frailty make manual manoeuvres difficult.
- Use manual repositioning manoeuvres as first-line for uncomplicated BPPV.
- Consider a rotational chair where mobility limits manual manoeuvres.
- Expect more manoeuvres in older patients and after head trauma.
- Warn patients with osteoporosis or previous episodes about recurrence.
Why it matters
It means effective BPPV treatment does not depend on specialist equipment.
Don't overread it
Small, open-label and not powered to show equivalence; the advantage in over-65s is only a trend.
The statistics, in plain English
A p value of 0.19 for manoeuvre number means the difference between 2.25 and 1.82 could easily be chance. The large within-group fall in disability shows both methods work, not that they are identical.
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