Comparison of Postural Restriction with Cervical Soft Collar, Canalith Repositioning Procedure and Observation in the Initial Management of Benign Paroxysmal Positional Vertigo: A Randomized Control Trial

Background: Benign paroxysmal positional vertigo (BPPV) is a prevalent vestibular disorder often triggered by head position changes. While the canalith repositioning procedure (CRP) is a standard initial treatment, it has contraindications and potential complications. The present study investigated whether postural restriction with a cervical soft collar can serve as an equally effective initial management strategy for BPPV. Objective: To compare the effects of postural restriction with a cervical soft collar against CRP and observation in patients with BPPV. Materials and Methods: Seventy-five patients with a positive Dix-Hallpike test (DHT) were enrolled and randomly assigned to three groups, postural restriction with cervical soft collar, CRP, and observation. DHT results and Dizziness Handicap Inventory (DHI) scores were recorded. The presence of vertigo during CRP was assessed. Follow-ups were conducted in the first and second week. Results: The conversion rates from a positive to a negative DHT for the postural restriction group in the first and second week were 88% and 100%, and did not show statistically significant differences compared to the CRP group at 68% and 96%, but were significantly different from the observation group at 56% and 88% (p=0.0117 and 0.0184). DHI scores were similar between the soft collar and observation groups in the second week. Complications from CRP were noted in 12% of cases, with no complications reported in the other groups. Conclusion: Postural restriction with cervical soft collar may serve as an effective initial treatment for BPPV, comparable to CRP, without associated complications, and more effective than observation.