Treatment of horizontal canal BPPV—a randomized sham‐controlled trial comparing two therapeutic maneuvers of different speeds

OBJECTIVES: To compare the effect of a high‐speed barbecue maneuver with the modified Lempert maneuver and sham in patients with benign paroxysmal positional vertigo (BPPV) of the horizontal canal. METHODS: Randomized sham‐controlled, single blinded multicenter clinical trial in two university hospitals investigating consecutive patients with horizontal canal BPPV. Patients were randomly assigned to high‐speed barbecue (HSB), modified Lempert maneuver (ML), or sham maneuver (SM). All treatments were performed in a biaxial rotational chair with weekly follow‐up to a maximum of three treatment sessions. The final follow‐up was 3 months after the last treatment. RESULTS: Primary outcome: 2‐week recovery rate per protocol. Secondary outcome: Cumulative recovery rate and Dizziness Handicap Inventory (DHI) scores after 3 months per protocol (HSB and ML) and intention to treat (all groups). Fifty‐four patients were analyzed after 2 weeks (HSB = 17; ML = 20; SM = 17). Two‐week recovery rate was 14/17 after HSB, 11/20 after ML, and 4/17 after SM, with significantly better recovery in HSB [OR 15.17, 95% CI (1.85, 124.63), P = .001] using sham as base level. Recovery rate after 3 months was 15/17 after HSB and 15/19 after ML. Cumulative recovery rate showed no significant differences between the two treatment groups [95% CI (0.30, 13.14), P = .46] in cure rate DHI [95% CI (−16.56, 15.02), P = .92]. No unexpected adverse events were observed. CONCLUSION: Velocity change in horizontal canal BPPV treatment gives a faster initial recovery. Rapid recovery could reduce the disease burden. TRIAL REGISTRATION: Clinicaltrials.gov. Identifier: NCT01905800. LEVEL OF EVIDENCE: 1b