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Epley’s Manoeuvre: A Single Line Treatment for Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo

Indian Journal of Otolaryngology and Head & Neck Surgery volume 74, pages 3877–3882 (2022)Cite this article

Abstract

Benign Paroxysmal Positional Vertigo (BPPV) is the commonest cause of peripheral vertigo. Displaced free floating otoconia in the semicircular canals are responsible for brief attacks of vertigo and nystagmus. Epley’s manoeuvre relocates these particles into the utricle. Here we studied the efficacy of Epley’s manoeuvre in posterior semicircular canal BPPV without labyrinthine sedatives. 120 patients presented with positional vertigo were included in the study based on positive Dix- hallpike test from August 2018 to July 2019. These patients were treated with only the Epley’s manoeuvre and followed up for 6 months. Patients who were previously on labyrinthine sedatives were advised to stop them and treated with only the Epley’s manoeuvre. In our study of 120 patients, mean age was 43.5 yrs. Females (52.5%) were commonly affected. Left side posterior semicircular involvement was more than the right side. Epley’s manoeuvre had 90% efficacy at 1st week and 100% efficacy at 4th week. Duration of vertigo had significant association (p < 0.01) with the number of sessions required. There was significant improvement in the duration of vertigo attack (p < 0.0001) and frequency of attack (p < 0.0001) before and after the manoeuvre. Epley’s manoeuvre lead to significant (p < 0.001) improvement in the quality of life of affected patients measured by DHI scoring. In our 6 months follow up, 10 recurrences occurred having significant (p < 0.01) association with the duration of vertigo attack. Only Epley’s manoeuvre without any labyrinthine sedatives is an effective treatment for posterior semicircular canal BPPV patients. It also improves the quality of life of affected patients.

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Abbreviations

BPPV:

Benign Paroxysmal Positional Vertigo

DHI:

Dizziness Handicap Inventory

References

  1. Furman J, Cass S (1999) Benign paroxysmal positional vertigo. N Engl J Med 341(21):1590–1596

    Article  CAS  Google Scholar 

  2. Parnes LS, Agrawal SK, Atlas J (2003) Diagnosis and management of Benign paroxysmal positional vertigo. Can Med Assoc J 169:681–693

    Google Scholar 

  3. Froehling D, Bowen J, Mohr D, Breyr, Beatty C, Wollan P et al (2000) The canalith repositioning procedure for the treatment of benign paroxysmal positional vertigo: a randomized controlled trial. Mayo Clinic Proceedings. 75(7): 695–700.

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

    Article  Google Scholar 

  5. Lynn S et al (1995) Randomized trial of the canalith repositioning procedure. Otolaryngol-Head Neck Surg 113(6):712–720

    Article  CAS  Google Scholar 

  6. Burton MJ, Eby TL, Rosenfeld RM (2012) Extracts from the cochrane Library:modifications of the Epley (canalith repositioning) maneuver for posterior canal benign paroxysmal positional vertigo. Otolaryngol-Head Neck Surg Off J Am Acad Otolayngol-Head Neck Surg. 147(3):407–11.

  7. Davies RA, Luxon LM (1995) Dizziness following head injury:A neuro-otological study. J Neurol. 1;242(4):222–30.

  8. Hornibrook J (1998) Immediate onset of positional vertigo following head injury. N Z Med J. 11;111(1073):349.

  9. Harada K, Oda M, Yamamoto M, Nomura T, Ohbayashi S, Kitsuda C (1993) A clinical observation of benign paroxysmal positional vertigo(BPPV) after vestibular neuronitis(VN).Acta Oto-Laryngol Suppl.503:61–3.

  10. Gyo K (1988) Benign paroxysmal positional vertigo as a complication of postoperative bedrest.The laryngoscope. 1; 98:332–3.

  11. Moon SY, Kim JS, Kim B-K, Kim JI, Lee H, Son S-I, et al. (2006) Clinical characteristics of Benign Paroxysmal Positional Vertigo in Korea: A multicentre Study. J Korean Med Sci. 21(3):539–43.

  12. Nuti D, Mandala M, Salerni L (2009) Lateral canal paroxysmal positional vertigo revisited.Ann N Y Acad Sci. 1164:316–23.

  13. Epley JM (1992) The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo.Otolaryngol—Head Neck Surg Off J am Acad Otolaryngol-Head Neck Surg. 107(3):399–404.

  14. Woodworth B, Gillespie M, Lambert P (2004) The Canalith Repositioning Procedure for Benign Positional Vertigo:A meta –analysis .Laryngoscope. 114(7) :1143–6.

  15. Manayil John H, John A (2016) Efficacy of Epley’s manoeuvre in posterior canal benign paroxysmal positional vertigo. J Evid Based Med Healthc 3(102):5624–5627

    Article  Google Scholar 

  16. Baloh RW, Honrubia V, Jacobson K (1987) Benign positional vertigo: clinical and oculographic features in 240 cases. Neurol 37(3):371–378

    Article  CAS  Google Scholar 

  17. Gaur S, Awasthi S, Bhadouriya S, Saxena R, Pathak V, Bisht M (2015) Efficacy of epley’s maneuver in treating bppv patients: a prospective observational study. Inter J Otolaryngol 2015:1–5

    Article  Google Scholar 

  18. Sundararajan I, Rangachari V, Sumathi V, Kumar K (2011) Epley’s manoeuvre versus Epley’s manoeuvre plus labyrinthine sedative as management of benign paroxysmal positional vertigo: prospective, randomised study. J Laryngol Otol 125(6):572–575

    Article  CAS  Google Scholar 

  19. André A, Moriguti J, Moreno N (2010) Condutas pós-manobra de Epley em idosos com VPPB de canal posterior. Braz J Otorhinolaryngol 76(3):300–305

    Article  Google Scholar 

  20. Elsanadiky H, Nour Y (2015) Diagnosis and management of posterior semicircular canal benign paroxysmal positional vertigo: A practical approach. Egypt J Ear, Nose, Throat Allied Sci 16(2):161–166

    Article  Google Scholar 

  21. Imai T, Okumura T, Sato T, Takeda N, Ohta Y, Okazaki S et al (2019) Effects of Interval Time of the Epley Maneuver on Immediate Reduction of Positional Nystagmus: A Randomized, Controlled, Non-blinded Clinical Trial. Frontiers in Neurology. 10.

  22. V vijayraj (2018) A comparison between the effect of Epley’s maneuver and Brandt-daroff exercise in improving the quality of life (QOL) in patients with benign paroxysmal positional vertigo (BPPV). Inter J Appl Dent Sci. 4(2):228–237.

  23. Choi SJ, Lee JB, Lim HJ et al (2012) Clinical features of recurrent or persistent benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 147:919–924

    Article  Google Scholar 

  24. Brandt T, Huppert D, Hecht J, Karch L, Strupp M (2006) Benign paroxysmal positional vertigo: A long term follow-up(6–17 years) of 125 patients. Acta Otolaryngol 126:160–163

    Article  Google Scholar 

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  1. Department of ENT, Dr. S.N. Medical college, Hostel no: 9, shastri nagar, Jodhpur, Rajasthan, India

    Diksha Gupta & Bharti Solanki

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  1. Diksha Gupta
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  2. Bharti Solanki
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Correspondence to Diksha Gupta.

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Gupta, D., Solanki, B. Epley’s Manoeuvre: A Single Line Treatment for Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo. Indian J Otolaryngol Head Neck Surg 74 (Suppl 3), 3877–3882 (2022). https://doi.org/10.1007/s12070-021-02695-6

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  • DOI: https://doi.org/10.1007/s12070-021-02695-6

Keywords

  • Vertigo
  • Benign
  • Positional
  • Manoeuvre