Effectiveness of Ryokeijutsukanto in the Treatment of Benign Paroxysmal Positional Vertigo (BPPV).

Background Benign paroxysmal positional vertigo (BPPV) is the most common acute vertigo disorder caused by otolith displacement in the inner ear. Recurrence, particularly in older adults, poses a significant clinical challenge. Objectives This study evaluates the therapeutic effects of ryokeijutsukanto, a Kampo medicine, on BPPV when used adjunctively with the Brandt-Daroff (BD) method. Methods A prospective cohort study was conducted following the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. Forty-eight BPPV patients were divided into three groups: Group A (BD method only, N=8), Group B (BD method + Kampo, N=11), and Group C (BD method + betahistine 36 mg, N=29). As Kampo, ryokeijutsukanto 7.5 mg was given three times a day before meals, divided into three doses. The BD method was performed daily, and the outcomes were measured by subjective improvement and positional nystagmus resolution. Results Positional nystagmus resolution occurred in 38.3 ± 34.5 days (Group A), 30 ± 30.2 days (Group B), and 20.8 ± 21.4 days (Group C), with no statistically significant differences between groups. Subjective improvements were observed in 55% (6/11) of patients in Group B. Conclusions While ryokeijutsukanto did not significantly impact nystagmus resolution times, it enhanced subjective outcomes and adherence, suggesting its potential as an adjunctive therapy in BPPV management.