Efficacy of Vestibular Rehabilitation Therapy on Benign Paroxysmal Positional Vertigo After Repositioning: Improvement of Vestibular Symptoms and Vertigo Disability

Objective: This research was targeted to investigate the efficacy of vestibular rehabilitation therapy (VRT) for patients with benign paroxysmal positional vertigo (BPPV) experiencing residual symptoms after repositioning, and to examine subtype-specific differences between posterior canal BPPV (pc-BPPV) and horizontal canal BPPV (hc-BPPV). Method: A prospective, stratified randomized controlled design was used, enrolling patients with BPPV who exhibited residual symptoms [Dizziness Handicap Inventory (DHI) ≥20 points] following repositioning between January 2024 and January 2025. Following standardized repositioning (modified Epley maneuver for pc-BPPV, Gufoni/Barbecue maneuver for hc-BPPV), patients were stratified by subtype and randomized into a VRT group and a control group. The VRT group received combined sequential VRT treatment with medication (betahistine hydrochloride+ginkgolide), incorporating traditional vestibulo-ocular reflex (VOR) adaptation training (eg, adaptive head movements) and habituation training for positional vertigo (eg, modified Brandt-Daroff training) over 28 days. The control group was given medication alone. The DHI, visual analogue scale (VAS), balance function (static closed-eye standing ≥60 s), and dynamic visual acuity (DVA, horizontal head movement) at baseline, 14 days and 28 days were evaluated. Results: This study included 207 BPPV patients with residual symptoms after repositioning (110 in the control group and 97 in the VRT group). The overall efficacy of the VRT group was significantly better than that of the control group, as evidenced by lower 28-day DHI (18.00 vs. 28.00, P <0.001) and VAS (1.60±1.40 vs. 3.46±1.45, P <0.001), higher balance compliance rate (88.7% vs. 61.8%, P <0.001) and DVA improvement (3 lines vs. 1 line, P =0.001). Subgroup analysis revealed that core efficacy were generally consistent between pc-BPPV and hc-BPPV in the VRT group, but subtype-specific differences emerged: pc-BPPV demonstrated faster early vertigo relief (ΔDHI_14 d, P =0.030), while hc-BPPV showed superior DVA improvement ( P =0.009). Within the control group, pc-BPPV demonstrated more pronounced early vertigo relief (ΔVAS_14 d, P <0.001) and long-term disability improvement (ΔDHI_28 d, P =0.021) during spontaneous recovery. VRT could remodel this difference, eliminating the long-term disadvantage of hc-BPPV and transforming the early advantage of pc-BPPV into rapid disability improvement. Conclusion: VRT significantly improves residual symptoms in BPPV after repositioning. Subtype-specific differences exist between pc-BPPV and hc-BPPV in early VRT efficacy and functional recovery dimensions, providing evidence for precision rehabilitation classification.