BPPV Treatment: The TRV Advantage


By Cammy Bahner, Au.D., CCC-A

The TRV Chair is an innovative approach to the diagnosis and treatment of Benign Paroxysmal Positional Vertigo (BPPV). It allows for 360° movement in all semicircular canal planes, all while monitoring and recording patient eye movements, so that any form of BPPV can be treated. Because of the safety features of the chair, patients feel very secure while going through an evaluation and treatment process. Even patients with limited mobility due to neck or back issues, or those that are frail, are still able to be successfully treated in the secure TRV chair, where the more typical bedside BPPV treatments may not be possible.

Unlike other chairs developed for treating BPPV that utilize automated mechanical procedures, the TRV chair allows the clinician to make manual real-time adjustments for successful treatments. According to West et al (2019), patients with refractory BPPV experience significant improvement with treatments in the TRV chair according to their subjective outcomes measures of Dizziness Handicap Inventory (DHI) and the Hospital Anxiety and Depression Scale (HADS). Additionally, it has been reported that treatment efficacy is significantly better using the TRV chair compared to manual beside maneuvers and that the number of treatment sessions needed for successful repositing is lower than with manual maneuvers (Tan et al, 2014). Wang et al (2014) reported that the most important aspect of the TRV chair is that the patient’s head and trunk can be made stationary, thereby increasing the patient’s safety during BPPV treatments, particularly in those difficult treatments, such as cupulolithiasis horizontal canal BPPV.

The optional potentiated “impact” treatment procedures in the TRV chair effectively add decelerations as liberatory forces for a more natural treatment of BPPV. These potentiated treatments have been studied extensively. According to Richard-Vitton, et al (2013), these decelerations help to dislodge the otoconia particles to facilitate in debris migration through the semicircular canal during BPPV treatment. Wang et al (2014) further explained that these decelerations that occur after a sudden stop of the chair during treatment can be effective for moving even the smallest otoconia in cupulolithiasis cases of BPPV.

Physicians, audiologists, physical therapists and researchers from around the world met for a TRV workshop in Denmark earlier this summer to collaborate with experts in BPPV assessment and treatment. Alaina Bassett, Ph.D., professor in the Department of Communication Disorders at Cal State LA, said, “The TRV workshop was a great opportunity to learn from providers around the world who are using the TRV chair in their daily practice. Their experiences and feedback helped me to better understand how to develop protocols integrating the TRV chair into the treatment plan for BPPV. I gained an appreciation for counseling techniques and ways to modify the chair to meet the needs of the complex patients we serve. I am looking forward to getting back to the clinic to apply what I have learned!”

Dr. Bassett was able to bring her skills from the Denmark workshop back home for Cal State’s own vestibular educational seminar In July, sponsored by Interacoustics, U.S. Vestibular audiologists from around the U.S. gathered in their state-of-the-art vestibular lab to see the benefits of the TRV chair firsthand. Dr. Bassett led groups of attendees through correct placement of patients in the chair, and how to perform an Epley maneuver using the TRV chair, as well as common treatments for lateral canal BPPV using TRV. She explained the advantages of using the TRV chair for treating patients with the difficult multi-canal cases.

The TRV chair offers an efficient alternative to traditional maneuvers for those cases of refractory BPPV, as well as for cases where a patient may not be able to be maneuvered effectively with typical bedside treatments. Numerous publications point out the safety advantages of the TRV chair, along with the potentiated treatments for a more effective and natural way of treating patients with BPPV.

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Richard-Vitton T, Petrak M, Beck DL (2013). The TRV chair: introductory concepts. Hearing Review 20(12), 52-54.

Tan J, Yu D, Feng Y, Song Q, You J, Shi H, Yin S (2014). Comparative study of the efficacy of the canalith repositioning procedure versus the vertigo treatment and rehabilitation chair. Acta Oto-Laryngologica 134(7), I704-708.

Wang J, Chi FL, Jia XH, Tian L, Richard-Vitton T (2014). Does benign paroxysmal positional vertigo explain age and gender variation in patients with vertigo by mechanical assistance maneuvers? Neurol Sci 35, 1731-1736.

West N, Hansen S, Moller MN, Bloch SL, Klokker M (2016). Repositioning chairs in benign paroxysmal positional vertigo: implications and clinical outcome. Eur Arch Otorhinolaryngol 273(3), 573-580.

West N, Hansen S, Moller MN, Bloch SL, Klokker M (2019). Reposition chair treatment improves subjective outcomes in refractory benign paroxysmal positional vertigo. J Int Adv Otol 15(1), 146-150.