The purpose of this study is to determine the relative short- and long-term efficacy of several physical treatment paradigms commonly employed for the treatment of benign paroxysmal positional vertigo (BPPV), including the Epley maneuver, the Semont maneuver, the Brandt-Daroff exercises and nonspecific vestibular habituation exercises. These procedures involve exercises and head manipulations. Vertigo intensity and frequency, the presence/absence of slow-phase eye movements, the degree of dizziness handicap and acts of daily living (ADL) shall be assessed. The study will also ascertain the effects of co-morbid conditions on the response to treatment. While BPPV is a common and significant public health problem that has been recognized for several decades, this is the first systematic study of the relative treatment efficacy of different physical treatment modalities for this disorder.

• Behavioral: Epley maneuver
• Procedure: Semont maneuver
• Procedure: Brandt-Daroff exercises
• Procedure: Vestibular habituation exercises
• Procedure: Epley Maneuver

• Vegunta RK, Wallace LJ, Leonardi MR, Gross TL, Renfroe Y, Marshall JS, Cohen HS, Hocker JR, Macwan KS, Clark SE, Ramiro S, Pearl RH. Perinatal management of gastroschisis: analysis of a newly established clinical pathway. J Pediatr Surg. 2005 Mar;40(3):528-34.
• Cohen HS, Kimball KT, Stewart MG. Benign paroxysmal positional vertigo and comorbid conditions. ORL J Otorhinolaryngol Relat Spec. 2004;66(1):11-5.
• Cohen HS, Kimball KT. Treatment variations on the Epley maneuver for benign paroxysmal positional vertigo. Am J Otolaryngol. 2004 Jan-Feb;25(1):33-7.
• Cohen HS. Side-lying as an alternative to the Dix-Hallpike test of the posterior canal. Otol Neurotol. 2004 Mar;25(2):130-4.

Inclusion Criteria:

Patients may be eligible for this study if they:

• Are at least 21 years old.
• Have a diagnosis of unilateral posterior semicircular canal BPPV according to established clinical test criteria.
• Have functional to normal range of motion of the neck and the back.

Exclusion Criteria:

Patients will not be eligible for this study if they:

• Have a history of prior ear surgery or prior treatment for BPPV.
• Have an orthopedic or connective tissue disorder that impairs functional neck or trunk range of motion.
• Have a significant neurological disorder or spinal cord damage.
• Are on vestibular suppressant medications.
• Have Meniere's disease or acoustic neuromas.