Repositioning Chairs in the Diagnosis and Treatment of Benign Paroxysmal Positional Vertigo - A Systematic Review

Multi-axial repositioning chairs such as the TRV chair and the Epley Omniax Rotator (EO) are newer alternatives in the treatment of complex and recurrent cases of the common peripheral vertigo disorder, benign paroxysmal positional vertigo (BPPV). The objective of this systematic review is to collect and synthesize current knowledge on the clinical characteristics of repositioning chairs for treatment of BPPV. A systematic search of the PubMed and EmBase databases was conducted and data regarding clinical characteristics were extracted from both retrospective and prospective studies, and a qualitative synthesis was made. Of 36 unique publications, 9 studies were considered eligible, containing data from 3383 subjects. No randomized controlled trials were found. The included studies were found to have a high risk of bias and the overall quality of evidence was low. The type of referred patients and follow-up periods varied. Recurrence rates varied between 11% and 27.9%. Incidence of rarer types of BPPV was higher in the included studies than previous estimates. The rate of symptom relief was high, and clinical outcomes were similar between posterior canal BPPV (p-BPPV) and non-P BPPV. The included studies show repositioning chairs to be a safe and effective treatment for BPPV, especially for rarer forms and in patients unable to perform manual treatment. However, data from randomized controlled trials are needed to compare with conventional methods to examine their efficacy, to determine indications for treatment, and to decide whether they should be used as first-line treatment.