The role of temporomandibular joint mobilization in the management of benign paroxysmal positional vertigo: randomized controlled trial

Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder and is characterized by brief episodes of vertigo triggered by changes in head position. Although canalith repositioning maneuvers effectively treat the underlying mechanical pathology, cranio-cervical musculoskeletal factors may influence dizziness perception and postural control. Temporomandibular joint (TMJ) dysfunction has been associated with vestibular symptoms, including dizziness, imbalance, and tinnit us. This study evaluated the effectiveness of TMJ and soft tissue mobilization as an adjunct to standard treatment in individuals with BPPV. In this parallel-group randomized controlled trial, 42 adults diagnosed with BPPV were randomly allocated using simple randomization to an intervention group or a control group. One participant was excluded due to non-adherence, and 41 participants completed the study (intervention n = 20; control n = 21; mean age 53.9 ± 9.8 years). The intervention group received TMJ and soft tissue mobilization once weekly for four weeks in addition to canalith repositioning maneuvers, while the control group received standard treatment alone. The primary outcome was dizziness-related disability assessed using the Dizziness Disability Inventory. Additional outcomes included assessments of temporomandibular function and postural balance. Independent t-tests, Mann-Whitney U tests, paired t-tests, and Wilcoxon tests were applied. Both groups demonstrated significant improvements in dizziness-related outcomes (p < 0.001). However, no significant between-group differences were observed for dizziness measures. The intervention group showed significantly greater improvement in temporomandibular function (p < 0.001). In addition, balance performance during tandem stance with eyes open improved significantly more in the intervention group compared with the control group (mean difference 3.90 s; 95% CI 1.70-6.10; p = 0.001). Adding temporomandibular joint and soft tissue mobilization to conventional treatment may improve balance performance and temporomandibular function in individuals with benign paroxysmal positional vertigo.Clinical trial registration number: ClinicalTrials.gov (NCT05944159; 24 July 2023).