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Analysis of risk factors influencing the outcome of the Epley maneuver

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

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.

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References

  1. Lee SH, Ji SK (2010) Benign paroxysmal positional vertigo. J Clin Neurol (Seoul, Korea) 6(2):51–63

    Article  Google Scholar 

  2. Hall SF, Ruby RR, McClure JA (1979) The mechanics of benign paroxysmal vertigo. J Otolaryngol 8:151–158

    CAS  PubMed  Google Scholar 

  3. Schuknecht HF (1969) Cupulolithiasis. Arch Otolaryngol 90:765–778

    Article  CAS  PubMed  Google Scholar 

  4. Parnes LS, Agrawal SK, Atlas J (2003) Diagnosis and management of benign paroxysmal positional vertigo (BPPV). CMAJ 169:681–693

    PubMed  PubMed Central  Google Scholar 

  5. Epley JM (1992) The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 107:399–404

    Article  CAS  PubMed  Google Scholar 

  6. 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):2067–2074

    Article  CAS  PubMed  Google Scholar 

  7. Halmagyi GM, Curthoys IS (1988) A clinical sign of canal paresis. Arch Neurol 45(7):737–739

    Article  CAS  PubMed  Google Scholar 

  8. Pagnini P, Nuti D, Vannucchi P (1989) Benign paroxysmal vertigo of the horizontal canal. ORL J Otorhinolaryngol Relat Spec 51(3):161–170

    Article  CAS  PubMed  Google Scholar 

  9. McClure JA (1985) Horizontal canal BPV. J Otolaryngol 14(1):30–35

    CAS  PubMed  Google Scholar 

  10. Dix MR, Hallpike CS (1952) The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system. Ann Otol Rhinol Laryngol 61(4):987–1016

    Article  CAS  PubMed  Google Scholar 

  11. von Brevern M, Bertholon P, Brandt T et al (2015) Benign paroxysmal positional vertigo: diagnostic criteria. J Vestib Res 25(3–4):105–117. doi:10.3233/VES-150553

    Article  Google Scholar 

  12. 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):1105–1110

    Article  PubMed  Google Scholar 

  13. Korres S, Balatsouras DG, Ferekidis E (2006) Prognosis of patients with benign paroxysmal positional vertigo treated with repositioning manoeuvres. J Laryngol Otol 120(7):528–533

    Article  CAS  PubMed  Google Scholar 

  14. Jang YS, Hwang CH, Shin JY, Bae WY, Kim LS (2006) Age-related changes on the morphology of the otoconia. Laryngoscope 116(6):996–1001

    Article  PubMed  Google Scholar 

  15. Ross MD, Peacor D, Johnsson LG, Allard LF (1976) Observations on normal and degenerating human otoconia. Ann Otol Rhinol Laryngol 85(3 pt 1):310–326

    Article  CAS  PubMed  Google Scholar 

  16. Korkmaz M, Korkmaz H (2016) Cases requiring increased number of repositioning maneuvers in benign paroxysmal positional vertigo. Braz J Otorhinolaryngol 82(4):452–457

    Article  PubMed  Google Scholar 

  17. Cohen HS, Kimball KT, Stewart MG (2004) Benign paroxysmal positional vertigo and comorbid conditions. ORL J Otorhinolaryngol Relat Spec 66(1):11–15

    Article  PubMed  Google Scholar 

  18. von Brevern M, Radtke A, Lezius F et al (2007) Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatr 78(7):710–715

    Article  Google Scholar 

  19. Sunami K, Tochino R, Tokuhara Y et al (2006) Effects of cigarettes and alcohol consumption in benign paroxysmal positioning vertigo. Acta Otolaryngol 126(8):834–838

    Article  PubMed  Google Scholar 

  20. Brandt T (1990) Positional and positioning vertigo and nystagmus. J Neurol Sci 95(1):3–28

    Article  CAS  PubMed  Google Scholar 

  21. Yetiser S, Gokmen MHA (2015) Clinical aspects of benign paroxysmal positional vertigo associated with migraine. Int Tinnitus J 19(2):64–68

    Article  PubMed  Google Scholar 

  22. Faralli M, Cipriani L, Del Zompo MR, Panichi R, Calzolaro L, Ricci G (2014) Benign paroxysmal positional vertigo and migraine: analysis of 186 cases. B-ENT 10(2):133–139

    CAS  PubMed  Google Scholar 

  23. Yu S, Liu F, Cheng Z, Wang Q (2014) Association between osteoporosis and benign paroxysmal positional vertigo: a systematic review. BMC Neurol 14:110. doi:10.1186/1471-2377-14-110

    Article  PubMed  PubMed Central  Google Scholar 

  24. Vibert D, Sans A, Kompis M et al (2008) Ultrastructural changes in otoconia of osteoporotic rats. Audiol Neurootol 13(5):293–301

    Article  PubMed  Google Scholar 

  25. 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):79–83

    Article  PubMed  Google Scholar 

  26. Lee NH, Ban JH, Lee KC, Kim SM (2010) Benign paroxysmal positional vertigo secondary to inner ear disease. Otolaryngol Head Neck Surg 143(3):413–417. doi:10.1016/j.otohns.2010.06.905

    Article  PubMed  Google Scholar 

  27. 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):919–924

    Article  PubMed  Google Scholar 

  28. 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):721–730

    Article  PubMed  Google Scholar 

  29. Harvey SA, Hain TC, Adamiec LC (1994) Modified liberatory maneuver: effective treatment for benign paroxysmal positional vertigo. Laryngoscope 104(10):1206–1212

    Article  CAS  PubMed  Google Scholar 

  30. Balatsouras DG, Aspris A, Ganelis P et al (2015) Duration of Benign paroxysmal positional vertigo as a predictor for therapy. B-ENT 11(3):199–203

    CAS  PubMed  Google Scholar 

  31. 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):750–752

    PubMed  Google Scholar 

  32. 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):104–108

    Article  PubMed  Google Scholar 

  33. 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):107–112

    CAS  PubMed  PubMed Central  Google Scholar 

  34. 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):1137–1146

    Article  PubMed  Google Scholar 

  35. 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):1008–1011

    Article  PubMed  Google Scholar 

  36. Marques PS, Catillo R, Santos M, Pérez-Fernández N (2014) Repositioning nystagmus: prognostic usefulness?. Acta Otolaryngol 134(5):491–496

    Article  PubMed  Google Scholar 

  37. Oh HJ, Kim JS, Han BI, Lim JG (2007) Predicting a successful treatment in posterior canal benign paroxysmal positional vertigo. Neurology 68(15):1219–1222

    Article  PubMed  Google Scholar 

  38. Sridhar S, Panda N (2005) Particle repositioning manoeuvre in benign paroxysmal positional vertigo: is it really safe? J Otolaryngol 34(1):41–45

    Article  PubMed  Google Scholar 

  39. 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):637–643

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Hospital Infanta Luisa, Calle San Jacinto 87, 41010, Seville, Spain

    E. Domínguez-Durán & H. Galera-Ruiz

  2. Hospital Universitari Joan XXIII, Tarragona, Spain

    E. Domènech-Vadillo & E. Figuerola-Massana

  3. Hospital Universitario Puerta del Mar, Cádiz, Spain

    M. G. Álvarez-Morujo de Sande & A. J. Martín-Mateos

  4. Hospital Universitario Marqués de Valdecilla, Santander, Spain

    R. González-Aguado & C. Morales-Angulo

  5. Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas De Gran Canaria, Spain

    G. Guerra-Jiménez & Á. Ramos-Macías

Authors
  1. E. Domínguez-Durán
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  2. E. Domènech-Vadillo
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  3. M. G. Álvarez-Morujo de Sande
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  4. R. González-Aguado
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  5. G. Guerra-Jiménez
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  6. Á. Ramos-Macías
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  7. C. Morales-Angulo
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  8. A. J. Martín-Mateos
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  9. E. Figuerola-Massana
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  10. H. Galera-Ruiz
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Corresponding author

Correspondence to E. Domínguez-Durán.

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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.

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

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Domínguez-Durán, E., Domènech-Vadillo, E., Álvarez-Morujo de Sande, M.G. et al. Analysis of risk factors influencing the outcome of the Epley maneuver. Eur Arch Otorhinolaryngol 274, 3567–3576 (2017). https://doi.org/10.1007/s00405-017-4674-9

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  • DOI: https://doi.org/10.1007/s00405-017-4674-9

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