The evaluation of the effects of betahistine in addition to the epley maneuver on the treatment and quality of life indices in posterior canal benign paroxysmal positional vertigo

OBJECTIVE: The purpose of this study is to evaluate the effects of betahistine given in addition to the Epley maneuver on the quality of life indices of patients who were admitted with the complaints of positional vertigo and were diagnosed as having posterior canal benign paroxysmal positional vertigo (BPPV) of the canalithiasis type.MATERIALS AND METHODS: A total of 72 patients between 18 and 79 years old who were referred to the Department of Otorhinolaryngology of Dokuz Eylül University Faculty of Medicine Hospital between November 2009 and March 2010 complaining of positional vertigo who were diagnosed as posterior canal BPPV with the Dix Hallpike (DH) test were enrolled in a prospective, controlled and double blinded study. The Epley maneuver was performed all patients. After all patients were grouped randomly. Approximately one third portion of all patients (22 patients), by giving no drug treatment after the Epley maneuver, the remaining of 50 patients, underwent Epley maneuvers in addition to the one week period and twice a day to use the original equivalent in my view, prepared the active ingredient (24 mg betahistin) and placebo-containing drugs in the same manner produced the blister packaging of work applying the physicians except by a physician was assigned randomly. After finishing the study, giving medications to patients by physicians to review the results of 26 patients placebo (Group 2), the betahistine group of 24 patients (Group 3) were included. All the patients were asked to return after a week for control DH tests. The study was completed upon observing that all the complaints and DH test findings of the patients were negative.RESULTS: Forty five (%62.5) of the patients were female and 27 (%37.5) were male, 28 cases (%38.8) were under the age of 50 years old and 44 were 50 years later. The average age was 53.18±12.12 years. Forty five cases (%62.5) were found to have BPPV on the right side and 27 cases (%37.5) on the left. The duration of the symptoms was 1 month in 61 cases (%84.7) and 2 months in 11 cases (%15.3). Vertigo attack lasted for less than a minute in 44 cases (%61.2) and longer than 1 minute in 28 of them (%38.8). Seventeen cases (%23.6) had previous BPPV in their medical history. There were accompanying sytemic diseases or predisposing conditions with hypertension in 21 (%29.2), hyperlipidemia in 19 (%26.4), diabetes mellitus in 13 (%18.05), depression in 3 (%4.2), migrane in 4 (%5.6), recent upper respiratory tract infection in 7 (%9.7), head trauma in 3 (%4.2) an a long period of bed rest in in 3 (%4.2) patients. When the efficacy of the treatments were compared between before and first week? control after treatment in groups, there were no statistically significant difference between groups was detected. When the efficacy of the treatments were compared between and within the groups; it was found that the decrease in the symptoms and improvement in the quality of life scores were significantly more pronounced in Group 3 patients who belonged to any age group, complaining of dizziness since 1 months, attack durations of less than a minute.Recovery can not be achieved in 10 cases (%13.8) 1 weeks after the treatments, those cases were made to continue their previous treatment regimens and 1 week later all of them were found to be symtom free with negative DH test results. The recovery at the weeks was found to be more pronounced in Group 3 patients, as well.CONCLUSIONS: In our study, efficacy in treatment of BPPV, between all three treatment groups were no difference. However, betahistine in addition to the Epley maneuver for the treatment of posterior canal BPPV of the canalitithasis type is more effective than the Epley maneuvre alone or combined with placebo with regard to sypmtomatic and quality of life improvements in patients under the age of 50 years and 50 years later to all age groups, complaining of dizziness approximately one month period in patients, attack durations of less than a minute and treatment after first checking the complaints go on and the second sessions in these cases.Key words: Posterior canal BPPV, Dix Hallpike test, Epley maneuver, Betahistine