Effective Treatments for Dizziness After BPPV: A Clinical Study

Medipol University

Status: Completed

Conditions: Residual Disease; BPPV; Vestibular Disease

Treatments: Behavioral: Brandt-Daroff Exercises; Other: Theta Binaural Beats; Behavioral: Cawthorne-Cooksey Exercises

Study type: Interventional

Funder types: Other

Identifiers

NCT06936345

E-10840098-772.02-5857

Details and patient eligibility

About

This clinical study aimed to evaluate how effective vestibular rehabilitation therapy (VRT) and Theta Binaural Beats (T-BB) are in reducing dizziness and anxiety in patients who continue to feel unsteady after successful treatment for a common inner ear condition called BPPV. A total of 56 adult patients were divided into three groups, each receiving different types of home-based exercises: Cawthorne-Cooksey Exercises (CCE), Brandt-Daroff Exercises (BDE), or CCE combined with T-BB. The study measured both physical balance and emotional symptoms such as anxiety. Results showed that all treatments helped, but patients who received CCE with T-BB showed the most improvement in both balance and anxiety levels. The findings suggest that combining physical and audio-based therapy may be especially helpful for people with ongoing dizziness after BPPV.

Full description

Residual dizziness (RD) is a common yet often overlooked condition that can persist after successful canalith repositioning procedures (CRP) for benign paroxysmal positional vertigo (BPPV). Despite the resolution of vertigo, many patients continue to report imbalance and anxiety, which may affect their quality of life. This study investigated whether vestibular rehabilitation therapies-specifically Cawthorne-Cooksey Exercises (CCE), Brandt-Daroff Exercises (BDE), and CCE combined with Theta Binaural Beats (CCE+T-BB)-could improve balance and reduce anxiety in patients experiencing RD.

Fifty-six adults aged 18-60 who reported dizziness for at least 20 days after CRP were enrolled. Participants were assigned to one of the three intervention groups based on auditory sensitivity. The interventions were home-based, guided by digital content through the Moodle platform, and lasted four to six weeks depending on the protocol. The CCE+T-BB group also received 10-minute daily auditory stimulation designed to modulate brainwave activity and support emotional regulation.

The study used both objective (Sensory Organization Test - SOT) and subjective (Dizziness Handicap Inventory - DHI, State-Trait Anxiety Inventory - STAI) tools to assess outcomes before and after the interventions. All groups showed improvements, but the CCE+T-BB group demonstrated superior gains in balance, especially under visually and vestibular-dependent conditions. Both CCE-based groups had significant reductions in trait and state anxiety, while the BDE group only showed improvement in trait anxiety.

These findings suggest that structured vestibular rehabilitation improves balance and reduces anxiety in patients with residual dizziness. Furthermore, adding auditory neuromodulation (T-BB) to CCE may enhance postural adaptation and emotional regulation, supporting a multimodal, non-pharmacological approach to RD management. This research represents the first clinical evaluation of Theta Binaural Beats as an adjunct to vestibular therapy and offers a promising direction for personalized rehabilitation.

Enrollment: 56 patients

Sex: All

Ages: 18 to 60 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Diagnosed with unilateral posterior canal benign paroxysmal positional vertigo (BPPV)
• Successfully treated with canalith repositioning procedures (CRP)
• Experiencing persistent dizziness or imbalance lasting at least 20 days after CRP
• Able and willing to perform home-based vestibular rehabilitation exercises
• Provided informed consent to participate in the study

Exclusion criteria

• Presence of other vestibular or neurological disorders (e.g., Meniere's disease, multiple sclerosis)
• History of psychiatric conditions that may interfere with participation
• Use of medications affecting vestibular function or anxiety within the last 4 weeks
• Conductive or sensorineural hearing loss
• Cognitive impairment or inability to follow digital instructions
• Previous participation in vestibular rehabilitation within the past 6 months

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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56 participants in 3 patient groups

Cawthorne-Cooksey Exercises (CCE) Group

Experimental group

Description:

Participants in this group performed home-based Cawthorne-Cooksey vestibular rehabilitation exercises over a six-week period. Exercises were adjusted biweekly based on individual progress.

Treatment:

Behavioral: Cawthorne-Cooksey Exercises

CCE with Theta Binaural Beats (CCE+T-BB)

Experimental group

Description:

Participants followed the same six-week Cawthorne-Cooksey protocol as Arm 1, with an additional 10-minute daily Theta Binaural Beats audio session via stereo headphones.

Treatment:

Behavioral: Cawthorne-Cooksey Exercises

Other: Theta Binaural Beats

Brandt-Daroff Exercises (BDE) Group

Active Comparator group

Description:

Participants performed traditional Brandt-Daroff Exercises three times daily for four weeks. Exercises were done at home using video instructions and monitored weekly.

Treatment:

Behavioral: Brandt-Daroff Exercises