Vestibular rehabilitation therapy is a well-established treatment modality for patients with vestibular problems.

Performing vestibular rehabilitation therapy in a closely monitored setting may result in a better outcome than a home exercise programme.

A retrospective study was conducted of patients undergoing vestibular rehabilitation therapy between June 2005 and November 2012 in a tertiary university hospital. The Dynamic Gait Index, the main outcome measure, was utilised before and after the rehabilitation programme. The magnitude of improvement for all patients was analysed, mainly to compare the home exercise group with the closely monitored therapy group.

Only 32 patients underwent the vestibular rehabilitation therapy programme. In all patients, there was significant improvement in the mean Dynamic Gait Index score (from 11.75 to 17.38; p < 0.01). Dynamic Gait Index improvement was significantly higher with closely monitored therapy (mean improvement of 7.83 vs 2.79; p < 0.01).

The small sample size is a major limitation; nevertheless, closely monitored vestibular rehabilitation therapy resulted in improved performance status. More studies are needed to establish the efficiency of vestibular rehabilitation therapy and compare closely monitored therapy with tailored home exercise rehabilitation.

To assess the long-term efficacy of Epley's manoeuvre performed to treat benign paroxysmal positional vertigo.

Two hundred and sixty-nine patients suffering benign paroxysmal positional vertigo were offered Epley's manoeuvre. After five years, follow up was arranged. One hundred and three patients attended for follow up (58 women and 45 men; age range 19–65 years). As mentioned 269 patients were offered the EM and 103 of them were available for follow up. Prior to initial Epley's manoeuvre treatment, these patients' duration of benign paroxysmal positional vertigo had ranged from four to 96 weeks.

Five years after treatment of benign paroxysmal positional vertigo with Epley's manoeuvre, 65 per cent of patients reported no further attacks. Kaplan–Meier testing showed that the time to recurrence was significantly longer in patients aged less than 40 years, those with a duration of attacks of less than three years prior to initial Epley's manoeuvre treatment, and those suffering less than six exacerbations prior to initial Epley's manoeuvre treatment. Gender had no effect on time to recurrence. Duration of illness before receiving Epley's manoeuvre was the only independent predictor of recurrence.

Epley's manoeuvre remains an effective modality for treatment of benign paroxysmal positional vertigo. A patient age of less than 40 years and duration of attacks of less than three years are good prognostic factors. Exacerbation number and gender do not affect the probability of benign paroxysmal positional vertigo recurrence after five years; however, these factors do affect the duration of time free from the condition.