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An Exercise Therapy for the Cupulolithiasis of BPPV

Objective: Determine if an exercise therapy was effective for cases with benign paroxysmal positional vertigo (BPPV) suggesting cupulolithiasis of the horizontal semicircular canal as characterized by apogeotropic direction-changing nystagmus. Method: We describe herein our head tilt-hopping (HtH) exercise designed to release and move otoconia adhesive to the cupula. HtH exercises were performed in 14 subjects who were trained to hop with their heads tilted laterally and completed 3 to 5 training sessions a day over a 4-week period. Results: The nystagmus beating toward the uppermost ear disappeared or decreased immediately after the first trial with the exercise in 3 (21.4%) or 2 (14.3%) of 14 cases, respectively. The number of subjects showing improvement as assessed by the disappearance or decrease of the nystagmus were in 9 (64.3%) and 11 (78.6%) of all cases tested at 1 and 4 weeks’ time, respectively. However, the remaining 3 subjects were not affected by this treatment program after 4 week of the training. Conclusion: These results suggest that HtH exercises based on the concepts of release of otoconia from the cupula would appear to be feasible as a new therapy for cupulolithiasis associated with intractable horizontal canal BPPV.