• Juan E Munoz, Jonel T Miklea, Michelle Howard, Russ Springate, and Janusz Kaczorowski.
• Department of Family Medicine, McMaster University, McMaster Family Practice, 690 Main St W, Suite A, Hamilton, ON L8S 1A4. munozj@mcmaster.ca
• Can Fam Physician. 2007 Jun 1;53(6):1049-53, 1048.

ObjectiveTo determine whether the canalith repositioning maneuver (CRM) is effective for treating benign paroxysmal positional vertigo when it is used by family physicians in primary care settings.DesignRandomized, prospective, double-blind, sham-controlled trial.SettingAn academic family practice in Hamilton, Ont.ParticipantsEighty-one patients 18 years or older whose dizziness was confirmed by the Dix-Hallpike (DH) vertigo-triggering maneuver and who had no contraindications to the CRM.InterventionsAt the first visit, the intervention group received the CRM and the control group received a sham maneuver. Both groups received the CRM at the second and third visits 1 and 2 weeks later.Main Outcome MeasuresNegative results of the DH test or self-reported resolution of vertigo after the initial treatment.ResultsEighty-one patients were randomized and received the first treatment. After the first treatment, 34.2% of patients in the intervention group and 14.6% of patients in the control group had negative DH test results (relative risk 2.3, 95% confidence interval 1.03 to 5.2, P = .04); and 31.6% of patients in the intervention group and 24.4% of patients in the control group reported resolution of dizziness (relative risk 1.2, 95% confidence interval 0.7 to 1.9, P = .48). One week later, patients in both intervention and control groups received the CRM, and 61.8% and 57.1% of them, respectively, had negative DH test results (P = .81). By week 3, approximately 75% of patients in both groups had improved.ConclusionA statistically significant proportion of patients in the CRM group returned to a negative response to the DH maneuver immediately after the first treatment. Family physicians can use the CRM to treat benign paroxysmal positional vertigo and potentially avoid delays in treatment and unnecessary referrals.Trial Registration NumberNCT00182273 (ClinicalTrials.gov).

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