European Archives of Oto-Rhino-Laryngology

, Volume 274, Issue 10, pp 3567–3576 | Cite as

Analysis of risk factors influencing the outcome of the Epley maneuver

  • E. Domínguez-Durán
  • E. Domènech-Vadillo
  • M. G. Álvarez-Morujo de Sande
  • R. González-Aguado
  • G. Guerra-Jiménez
  • Á. Ramos-Macías
  • C. Morales-Angulo
  • A. J. Martín-Mateos
  • E. Figuerola-Massana
  • H. Galera-Ruiz


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 


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

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • E. Domínguez-Durán
    • 1
  • E. Domènech-Vadillo
    • 2
  • M. G. Álvarez-Morujo de Sande
    • 3
  • R. González-Aguado
    • 4
  • G. Guerra-Jiménez
    • 5
  • Á. Ramos-Macías
    • 5
  • C. Morales-Angulo
    • 4
  • A. J. Martín-Mateos
    • 3
  • E. Figuerola-Massana
    • 2
  • H. Galera-Ruiz
    • 1
  1. 1.Hospital Infanta LuisaSevilleSpain
  2. 2.Hospital Universitari Joan XXIIITarragonaSpain
  3. 3.Hospital Universitario Puerta del MarCádizSpain
  4. 4.Hospital Universitario Marqués de ValdecillaSantanderSpain
  5. 5.Complejo Hospitalario Universitario Insular Materno-InfantilLas Palmas De Gran CanariaSpain

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