Are Cervical Collars a Necessary Postprocedure Restriction in Patients With Benign Paroxysmal Positional Vertigo Treated With Particle Repositioning Maneuvers?

Introduction: Benign paroxysmal positional vertigo (BPPV) is managed with particle repositioning maneuvers (PRM), following which patients are advised of activity restrictions to prevent recurrence. This can include wearing a cervical collar. Objective: Does the use of BPPV postprocedure restriction with a cervical collar impact on the number of PRMs required to resolve a patient's symptoms? Method: Combination of retrospective and prospective review of 624 patients treated in a tertiary UK hospital. All were diagnosed with posterior canal BPPV and received a modified Epley maneuver (PRM). The “with cervical collar” (WC) retrospective group 2002 to 2009 (n = 263) were advised to wear a cervical collar for 48 hours postprocedure, and the “no cervical collar” (NC) prospective group 2010 to 2014 (n = 361) were not. The main outcome measure was the resolution of patient symptoms following a PRM for BPPV. Quantitative and statistical analysis using χ2 test was undertaken. Results: In the WC group, 84% (n = 221) had resolution of symptoms after the first PRM, versus 82.8% (n = 299) in the NC group. After the second PRM 11% (n = 29) resolved, versus 13.6% (n = 49) in the NC group. After the third PRM 4.9% (n = 13) resolved, versus 3.6% (n = 13) in the NC group. Both clinically and statistically there was no significant difference in outcome between groups. Conclusions: Our review of 624 patients is the largest study in this subject and the results demonstrate that wearing a cervical collar following PRM for BPPV concedes no significant benefit. Excluding this from postprocedure guidance allows patients to manage without the inconvenience of wearing a cervical collar, and allows departments to update clinical guidance.

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