Personalized Medicine to Treat Refractory Benign Paroxysmal Positional Vertigo Using Computational Fluid Dynamics From MRI Reconstructions

What this Trial Is About

Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo, often treated successfully with standard canalith repositioning maneuvers (CRMs). However, about 12.5% of cases do not respond, leading to persistent symptoms. This trial investigates whether personalized CRMs, guided by computational fluid dynamics (CFD) based on MRI scans, can better treat patients with refractory posterior canal BPPV by tailoring maneuvers to individual inner ear anatomy. The study is a randomized, open-label, multicenter trial comparing personalized treatment to standard care. Participants are randomly assigned to one of two groups. The control group performs Brandt-Daroff exercises at home twice daily for 8 weeks and may receive repeated standard CRMs with a mechanized chair if symptoms persist. The intervention group also performs Brandt-Daroff exercises and undergoes MRI imaging to create personalized treatment models. If needed, personalized maneuvers using a mechanical rotation chair are applied. These maneuvers are repeated biweekly up to eight times until symptoms resolve. The study spans from January 2024 to December 2026. Participants undergo thorough vestibular assessments, including otoscopy, neurological exams, positional tests, and audiometry, with MRI scans if symptoms persist. Follow-up visits occur at 8 weeks, 10 weeks, and 6 months post-inclusion, with monitoring of symptom resolution via Dix-Hallpike tests and dizziness impact questionnaires. Researchers will measure symptom resolution rates, number of treatment sessions, and quality of life changes. Safety and adherence are monitored throughout, with data analyzed for treatment effectiveness and healthcare use.

Personalized Treatment of Refractory BPPV