Betahistine for Residual Dizziness after the Epley Maneuver in Posterior Canal Benign Paroxysmal Positional Vertigo: A Randomized Double-Blind Placebo-Controlled Trial

Patanasukit, Kaveorn; Supakmontri, Thanapat; Tananuchittikul, Pornsek

doi:10.22038/ijorl.2026.97375.4208

Betahistine for Residual Dizziness after the Epley Maneuver in Posterior Canal Benign Paroxysmal Positional Vertigo: A Randomized Double-Blind Placebo-Controlled Trial

Document Type : Original

Authors

Kaveorn Patanasukit ¹

Thanapat Supakmontri ¹

Pornsek Tananuchittikul ²

¹ Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Thammasat University, Thammasat University Hospital, Pathum Thani, Thailand.

² Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Thammasat University, Thammasat University Hospital, Pathum Thani, Thailand and Division of Otology-Neurotology, Thammasat University, Thammasat University Hospital, Pathum Thani, Thailand.

10.22038/ijorl.2026.97375.4208

Abstract

Introduction:
Residual dizziness may occur after canalith repositioning procedures for posterior canal benign paroxysmal positional vertigo (BPPV) and can impair quality of life (QoL). This study assessed whether short-term betahistine improves QoL and promotes the resolution of residual dizziness after the Epley maneuver in patients with posterior canal BPPV.

Materials and Methods:
This randomized, double-blind, placebo-controlled trial screened 46 patients with posterior canal BPPV, all of whom underwent an Epley maneuver. Ten patients with persistent positional nystagmus at the 1-week reassessment were excluded before randomization, and the remaining 36 patients were randomized to receive betahistine 48 mg/day for 7 days or placebo after a successful Epley maneuver. Outcomes were assessed using the Visual Vertigo Analogue Scale (VVAS) and the Dizziness Handicap Inventory (DHI). The primary outcome was QoL improvement, while the secondary outcome was resolution of residual dizziness, defined as non-vertiginous dizziness in the absence of positional vertigo and positional nystagmus, assessed over 4 weeks.

Results:
All 36 randomized patients (18 per group) received the allocated intervention, completed follow-up, and were included in the analysis. VVAS and DHI scores improved significantly in both groups (p < 0.001), with no significant between-group differences. At 4 weeks, residual dizziness resolved in 77.8% of patients receiving betahistine and 66.7% of those receiving placebo, although the between-group difference was not statistically significant (p = 0.693).

Conclusions:
Short-term betahistine after a successful Epley maneuver did not significantly improve QoL compared with placebo, although the residual dizziness resolution rate was numerically higher in the betahistine group.

Keywords

Benign paroxysmal positional vertigo

Residual dizziness

Betahistine

Epley maneuver

Quality of life

Subjects