Benign paroxysmal positional vertigo (BPPV) is the most frequent type of vertigo. The treatment of canalithiasis of the posterior semicircular canal consists in performing a particle-repositioning maneuver, such as the Epley maneuver (EM). However, the EM is not effective in all cases. The objective of this study is to identify risk factors, which predict the EM failure, among the clinical variables recorded in anamnesis and patient examination. This is an observational prospective multicentric study. All patients presenting with BPPV were recruited and applied the EM and appointed for a follow-up visit 7 days later. The following variables were recorded: sex, age, arterial hypertension, diabetes, hyperlipidemia, smoking habit, alcohol consumption, migraine, osteoporosis, diseases of the inner ear, previous ipsilateral BPPV, previous traumatic brain injury, previous sudden head deceleration, time of evolution, sulpiride or betahistine treatment, experienced symptoms, outcome of the Halmagyi maneuver, laterality, cephalic hyperextension of the neck, intensity of nystagmus, intensity of vertigo, duration of nystagmus, occurrence of orthotropic nystagmus, symptoms immediately after the EM, postural restrictions, and symptoms 7 days after the EM. Significant differences in the rate of loss of nystagmus were found for six variables: hyperlipidemia, previous ipsilateral BPPV, intensity of nystagmus, duration of nystagmus, post-maneuver sweating, and subjective status. The most useful significant variables in the clinical practice to predict the success of the EM are previous BPPV and intensity of nystagmus. In the other significant variables, no physiopathological hypothesis can be formulated or differences between groups are too small.
BPPV Epley maneuver Prognosis Sex Age Hypertension Diabetes mellitus Hyperlipidemia Smoking Alcohol-related disorders Migraine disorders Osteoporosis Labyrinth diseases Traumatic brain injury Whiplash injuries Time-to-treatment Sulpiride Betahistine Signs and symptoms Head impulse test Lateralization Cervical extension Nystagmus Orthotropic nystagmus
This is a preview of subscription content, log in to check access.
Compliance with ethical standards
This study was not funded.
Conflict of interest
None of the author had conflict of interest in relation to the study.
Human and animal rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Lee SH, Ji SK (2010) Benign paroxysmal positional vertigo. J Clin Neurol (Seoul, Korea) 6(2):51–63CrossRefGoogle Scholar
Hall SF, Ruby RR, McClure JA (1979) The mechanics of benign paroxysmal vertigo. J Otolaryngol 8:151–158PubMedGoogle Scholar
Epley JM (1992) The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 107:399–404CrossRefPubMedGoogle Scholar
Fife TD, Iverson DJ, Lempert T et al (2008) Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence-based review): report of the quality standards subcommittee of the American academy of neurology. Neurology 70(22):2067–2074CrossRefPubMedGoogle Scholar
Babac S, Dragoslava D, Petrovic-Lazic M, Arsovic N, Aleksandar M (2014) Why do treatment failure and recurrences of benign paroxysmal positional vertigo occur? Otol Neurotol 35(6):1105–1110CrossRefPubMedGoogle Scholar
Korres S, Balatsouras DG, Ferekidis E (2006) Prognosis of patients with benign paroxysmal positional vertigo treated with repositioning manoeuvres. J Laryngol Otol 120(7):528–533CrossRefPubMedGoogle Scholar
Jang YS, Hwang CH, Shin JY, Bae WY, Kim LS (2006) Age-related changes on the morphology of the otoconia. Laryngoscope 116(6):996–1001CrossRefPubMedGoogle Scholar
Ross MD, Peacor D, Johnsson LG, Allard LF (1976) Observations on normal and degenerating human otoconia. Ann Otol Rhinol Laryngol 85(3 pt 1):310–326CrossRefPubMedGoogle Scholar
Korkmaz M, Korkmaz H (2016) Cases requiring increased number of repositioning maneuvers in benign paroxysmal positional vertigo. Braz J Otorhinolaryngol 82(4):452–457CrossRefPubMedGoogle Scholar
Vibert D, Sans A, Kompis M et al (2008) Ultrastructural changes in otoconia of osteoporotic rats. Audiol Neurootol 13(5):293–301CrossRefPubMedGoogle Scholar
Pollak L, Davies RA, Luxon LL (2002) Effectiveness of the particle repositioning maneuver in benign paroxysmal positional vertigo with and without additional vestibular pathology. Otol Neurotol 23(1):79–83CrossRefPubMedGoogle Scholar
Choi SJ, Lee JB, Lim HJ et al (2012) Clinical features of recurrent or persistent benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 147(5):919–924CrossRefPubMedGoogle Scholar
Aron M, Lea J, Nakku D, Westerberg BD (2015) Symptom resolution rates of posttraumatic versus nontraumatic benign paroxysmal positional vertigo: a systematic review. Otolaryngol Head Neck Surg 153(5):721–730CrossRefPubMedGoogle Scholar
Harvey SA, Hain TC, Adamiec LC (1994) Modified liberatory maneuver: effective treatment for benign paroxysmal positional vertigo. Laryngoscope 104(10):1206–1212CrossRefPubMedGoogle Scholar
Balatsouras DG, Aspris A, Ganelis P et al (2015) Duration of Benign paroxysmal positional vertigo as a predictor for therapy. B-ENT 11(3):199–203PubMedGoogle Scholar
Zhang H, Geng M, Yan B, Xing L (2012) Epley’s manoeuvre versus Epley’s manoeuvre plus labyrinthine sedative in the management of benign paroxysmal positional vertigo: prospective, randomised study. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 26(16):750–752PubMedGoogle Scholar
Guneri EA, Kustutanv O (2012) The effects of betahistine in addition to Epley maneuver in posterior canal benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 146(1):104–108CrossRefPubMedGoogle Scholar
Cavaliere M, Mottola G, Iemma M (2005) Benign paroxysmal positional vertigo: a study of two manoeuvres with and without betahistine. Acta Otorhinolaryngol Ital 25(2):107–112PubMedPubMedCentralGoogle Scholar
Squires TM, Weidman MS, Hain TC, Stone HA (2004) A mathematical model for top-shelf vertigo: the role of sedimenting otoconia in BPPV. J Biomech 37(8):1137–1146CrossRefPubMedGoogle Scholar
Soto-Varela A, Rossi-Izquierdo M, Santos-Pérez S (2011) Can we predict the efficacy of the semont maneuver in the treatment of benign paroxysmal positional vertigo of the posterior semicircular canal? Otol Neurotol 32(6):1008–1011CrossRefPubMedGoogle Scholar
Marques PS, Catillo R, Santos M, Pérez-Fernández N (2014) Repositioning nystagmus: prognostic usefulness?. Acta Otolaryngol 134(5):491–496CrossRefPubMedGoogle Scholar
Oh HJ, Kim JS, Han BI, Lim JG (2007) Predicting a successful treatment in posterior canal benign paroxysmal positional vertigo. Neurology 68(15):1219–1222CrossRefPubMedGoogle Scholar
Sridhar S, Panda N (2005) Particle repositioning manoeuvre in benign paroxysmal positional vertigo: is it really safe? J Otolaryngol 34(1):41–45CrossRefPubMedGoogle Scholar
Fyrmpas G, Rachovitsas D, Haidich AB et al (2009) Are postural restrictions after an Epley maneuver unnecessary? First results of a controlled study and review of the literature. Auris Nasus Larynx 36(6):637–643CrossRefPubMedGoogle Scholar