Abstract
Although the Epley maneuver is considered the primary treatment in BPPV, anti-vertigo medications are effective in residual symptoms. This study was designed to compare betahistine and dimenhydrinate plus the Epley maneuver and the Epley maneuver alone. This prospective cohort study was performed in Mashhad, Iran, from 2013 to 2015. 90 adult patients diagnosed with BPPV in hospitals and ENT clinics were selected through convenience sampling. Patients received betahistine 8 mg TDS or dimenhydrinate 50 mg once daily plus Epley or the Epley alone for four weeks. SF-36 and the DHI were used before and after the treatment. 49 were females (54.4%). The mean (SD) age was 47.9 (8.7) years. There was no significant difference between the groups in age (P = 0.753) and gender (P = 0.050).There were significant differences in all areas of SF-36 except for social activities in the dimenhydrinate group. There was a marginally significant difference between the betahistine and dimenhydrinate groups in role limitation due to physical health problems (P = 0.046). There were significant differences between the females and males in emotional well-being before and after treatment in the dimenhydrinate group (P = 0.014) and in terms of role limitation due to physical health problems in the Epley maneuver group (P = 0.022). Older patients in the betahistine group had better social activities after treatment (P = 0.048). In severe forms of BPPV, betahistine or dimenhydrinate might effectively reduce the symptoms.
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Appendix
Appendix
Dimenhydrinate group + Epley maneuver (male and female)
Test statistic P-value | Mean ± SD | Study groups | Variable | |
|---|---|---|---|---|
Post-treatment | Pre-treatment | |||
ANCOVA P-VALUE = 0/560 | 74/5 ± 16/4 | 45/2 ± 16/7 | Female | General health perceptions |
77/1 ± 21/9 | 46/2 ± 20/8 | Male | ||
ANCOVA P-VALUE = 0/691 | 77/0 ± 15/4 | 47/2 ± 13/5 | Female | Vitality |
69/5 ± 13/2 | 44/0 ± 17/3 | Male | ||
ANCOVA P-VALUE = 0/118 | 70/7 ± 15/4 | 47/5 ± 16/1 | Female | Physical functioning |
70/5 ± 16/1 | 36/5 ± 14/4 | Male | ||
ANCOVA P-VALUE = 0/297 | 62/5 ± 19/0 | 32/5 ± 20/0 | Female | Role limitation due to physical health problems |
80/0 ± 28/4 | 42/5 ± 42/6 | Male | ||
ANCOVA P-VALUE = 0/777 | 71/5 ± 15/8 | 39/7 ± 13/4 | Female | Bodily pain |
69/2 ± 11/1 | 38/0 ± 20/4 | Male | ||
ANCOVA P-VALUE = 0/014 | 62/2 ± 18/0 | 28/2 ± 18/7 | Female | Emotional well-being |
81/6 ± 14/0 | 37/2 ± 23/6 | Male | ||
ANCOVA P-VALUE = 0/076 | 76/6 ± 30/8 | 31/6 ± 31/5 | Female | Role limitation due to emotional problems |
60/0 ± 37/8 | 40/0 ± 41/0 | Male | ||
ANCOVA P-VALUE = 0/878 | 61/6 ± 29/1 | 43/6 ± 15/0 | Female | Social functioning |
42/0 ± 12/8 | 56/2 ± 17/2 | Male | ||
ANCOVA P-VALUE = 0/450 | 31/2 ± 14/8 | 56/1 ± 18/3 | Female | DHI |
27/4 ± 12/7 | 67/2 ± 26/5 | Male | ||
Betahistine + Epley maneuver group (male and female)
Test statistic P-value | Mean ± SD | Study groups | Variable | |
|---|---|---|---|---|
Post-treatment | Pre-treatment | |||
ANCOVA P-VALUE = 0/381 | 64/8 ± 17/1 | 42/1 ± 17/1 | Female | General health perceptions |
75/3 ± 10/6 | 47/5 ± 18/1 | Male | ||
ANCOVA P-VALUE = 0/941 | 72/2 ± 15/1 | 51/7 ± 13/5 | Female | Vitality |
75/8 ± 16/5 | 48/3 ± 16/3 | Male | ||
ANCOVA P-VALUE = 0/384 | 66/9 ± 16/6 | 44/4 ± 17/1 | Female | Physical functioning |
72/1 ± 7/8 | 53/3 ± 14/2 | Male | ||
ANCOVA P-VALUE = 0/438 | 59/7 ± 21/2 | 41/7 ± 30/9 | Female | Role limitation due to physical health problems |
54/2 ± 25/7 | 31/2 ± 32/2 | Male | ||
ANCOVA P-VALUE = 0/490 | 59/2 ± 16/0 | 39/9 ± 18/8 | Female | Bodily pain |
63/7 ± 15/1 | 54/0 ± 25/3 | Male | ||
ANCOVA P-VALUE = 0/440 | 57/3 ± 16/6 | 26/3 ± 22/2 | Female | Emotional well-being |
50/0 ± 16/1 | 54/3 ± 18/9 | Male | ||
ANCOVA P-VALUE = 0/321 | 51/8 ± 40/0 | 12/9 ± 20/2 | Female | Role limitation due to emotional problems |
52/7 ± 38/8 | 33/3 ± 37/5 | Male | ||
ANCOVA P-VALUE = 0/564 | 62/9 ± 22/6 | 41/2 ± 12/8 | Female | Social functioning |
61/0 ± 23/5 | 44/0 ± 30/3 | Male | ||
ANCOVAP-VALUE = 0/759 | 34/6 ± 16/5 | 56/0 ± 24/2 | Female | DHI |
31/2 ± 16/4 | 74/8 ± 23/9 | Male | ||
The Epley maneuver alone (female and male)
Test statistic P-value | Mean ± SD | Study groups | Variable | |
|---|---|---|---|---|
Post-treatment | Pre-treatment | |||
ANCOVA P-VALUE = 0/846 | 89/0 ± 12/3 | 41/6 ± 13/9 | Female | General health perceptions |
74/7 ± 16/5 | 41/9 ± 20/5 | Male | ||
ANCOVA P-VALUE = 0/837 | 69/5 ± 17/8 | 42/3 ± 11/0 | Female | Vitality |
72/6 ± 15/2 | 48/9 ± 13/0 | Male | ||
ANCOVA P-VALUE = 0/651 | 69/5 ± 10/3 | 48/4 ± 14/0 | Female | Physical functioning |
65/8 ± 12/9 | 45/0 ± 15/7 | Male | ||
ANCOVA *P-VALUE = 0/022 | 75/0 ± 22/4 | 34/1 ± 32/1 | Female | Role limitation due to physical health problems |
63/2 ± 31/6 | 34/2 ± 23/9 | Male | ||
ANCOVA P-VALUE = 0/103 | 72/3 ± 16/2 | 34/3 ± 13/3 | Female | Bodily pain |
71/8 ± 15/1 | 35/4 ± 15/0 | Male | ||
ANCOVA P-VALUE = 0/275 | 70/9 ± 26/5 | 22/5 ± 21/7 | Female | Emotional well-being |
78/1 ± 19/5 | 31/6 ± 22/0 | Male | ||
ANCOVA P-VALUE = 0/105 | 51/5 ± 37/6 | 15/1 ± 31/1 | Female | Role limitation due to emotional problems |
78/9 ± 16/5 | 26/3 ± 36/1 | Male | ||
ANCOVA P-VALUE = 0/849 | 67/3 ± 25/4 | 38/4 ± 15/5 | Female | Social functioning |
64/2 ± 24/3 | 43/0 ± 23/9 | Male | ||
ANCOVA P-VALUE = 0/665 | 40/2 ± 27/5 | 62/2 ± 28/1 | Female | DHI |
20/3 ± 18/6 | 60/1 ± 22/4 | Male | ||
Dimenhydrinate + Epley maneuver group (age groups below and above 40)
Test statistic P-value | Mean ± SD | Study groups | Variable | |
|---|---|---|---|---|
Post-treatment | Pre-treatment | |||
ANCOVA P-VALUE = 0/423 | 77/3 ± 17/8 | 49/2 ± 17/9 | 20 to 40 years | General health perceptions |
74/1 ± 18/6 | 43/4 ± 17/9 | 40 to 60 years | ||
ANCOVA P-VALUE = 0/715 | 69/5 ± 12/7 | 44/5 ± 15/4 | 20 to 40 years | Vitality |
77/4 ± 15/7 | 47/1 ± 14/6 | 40 to 60 years | ||
ANCOVA P-VALUE = 0/739 | 70/9 ± 14/3 | 49/1 ± 15/8 | 20 to 40 years | Physical functioning |
70/5 ± 16/3 | 40/8 ± 16/5 | 40 to 60 years | ||
ANCOVA P-VALUE = 0/469 | 70/4 ± 21/8 | 29/5 ± 21/8 | 20 to 40 years | Role limitation due to physical health problems |
67/1 ± 25/1 | 39/5 ± 32/6 | 40 to 60 years | ||
ANCOVA P-VALUE = 0/480 | 69/5 ± 13/9 | 36/1 ± 15/5 | 20 to 40 years | Bodily pain |
71/4 ± 14/7 | 40/9 ± 16/3 | 40 to 60 years | ||
ANCOVA P-VALUE = 0/540 | 70/5 ± 20/3 | 28/7 ± 18/3 | 20 to 40 years | Emotional well-being |
67/6 ± 18/7 | 32/6 ± 22/0 | 40 to 60 years | ||
ANCOVA P-VALUE = 0/368 | 72/7 ± 32/7 | 30/3 ± 27/7 | 20 to 40 years | Role limitation due to emotional problems |
70/2 ± 34/9 | 36/8 ± 38/3 | 40 to 60 years | ||
ANCOVA P-VALUE = 0/993 | 52/7 ± 25/2 | 50/2 ± 20/6 | 20 to 40 years | Social functioning |
56/5 ± 27/7 | 46/5 ± 14/3 | 40 to 60 years | ||
ANCOVA P-VALUE = 0/375 | 35/4 ± 14/6 | 61/1 ± 21/3 | 20 to 40 years | DHI |
26/7 ± 13/0 | 59/1 ± 22/3 | 40 to 60 years | ||
Betahistine + Epley maneuver group (age groups below and above 40 years)
Test statistic P-value | Mean ± SD | Study groups | Variable | |
|---|---|---|---|---|
Post-treatment | Pre-treatment | |||
ANCOVA P-VALUE = 0/806 | 63/3 ± 11/7 | 42/5 ± 21/2 | 20 to 40 years | General health perceptions |
71/8 ± 16/6 | 45/2 ± 15/8 | 40 to 60 years | ||
ANCOVA P-VALUE = 0/249 | 79/0 ± 13/5 | 54/5 ± 13/6 | 20 to 40 years | Vitality |
71/0 ± 16/0 | 48/2 ± 14/8 | 40 to 60 years | ||
ANCOVA P-VALUE = 0/788 | 65/0 ± 16/0 | 48/0 ± 19/0 | 20 to 40 years | Physical functioning |
71/0 ± 12/6 | 48/0 ± 15/4 | 40 to 60 years | ||
ANCOVA P-VALUE = 0/638 | 52/5 ± 14/2 | 42/5 ± 23/7 | 20 to 40 years | Role limitation due to physical health problems |
60/0 ± 26/2 | 35/0 ± 34/8 | 40 to 60 years | ||
ANCOVA P-VALUE = 0/849 | 58/5 ± 10/4 | 36/5 ± 24/5 | 20 to 40 years | Bodily pain |
62/2 ± 17/7 | 50/0 ± 20/4 | 40 to 60 years | ||
ANCOVA P-VALUE = 0/226 | 60/0 ± 19/8 | 36/4 ± 25/5 | 20 to 40 years | Emotional well-being |
51/6 ± 14/4 | 38/1 ± 25/3 | 40 to 60 years | ||
ANCOVA P-VALUE = 0/359 | 56/6 ± 38/6 | 30/0 ± 29/1 | 20 to 40 years | Role limitation due to emotional problems |
50/0 ± 39/7 | 16/7 ± 29/6 | 40 to 60 years | ||
ANCOVA *P-VALUE = 0/048 | 59/5 ± 24/2 | 42/5 ± 15/1 | 20 to 40 years | Social functioning |
63/5 ± 22/3 | 42/3 ± 24/0 | 40 to 60 years | ||
ANCOVA P-VALUE = 0/172 | 37/4 ± 12/1 | 57/6 ± 24/7 | 20 to 40 years | DHI |
31/1 ± 17/9 | 66/5 ± 26/0 | 40 to 60 years | ||
The Epley maneuver alone group (age groups below and above 40 years)
Test statistic P-value | Mean ± SD | Study groups | Variable | |
|---|---|---|---|---|
Post-treatment | Pre-treatment | |||
ANCOVA P-VALUE = 0/869 | 77/5 ± 20/7 | 42/9 ± 17/4 | 20 to 40 years | General health perceptions |
81/2 ± 14/2 | 41/2 ± 19/3 | 40 to 60 years | ||
ANCOVA P-VALUE = 0/803 | 71/0 ± 16/8 | 48/0 ± 10/3 | 20 to 40 years | Vitality |
71/7 ± 16/0 | 45/7 ± 13/8 | 40 to 60 years | ||
ANCOVA P-VALUE = 0/832 | 67/0 ± 13/4 | 50/0 ± 18/4 | 20 to 40 years | Physical functioning |
67/2 ± 11/6 | 44/5 ± 13/1 | 40 to 60 years | ||
ANCOVA P-VALUE = 0/592 | 62/5 ± 31/7 | 35/0 ± 21/1 | 20 to 40 years | Role limitation due to physical health problems |
70/0 ± 27/6 | 33/7 ± 29/5 | 40 to 60 years | ||
ANCOVA P-VALUE = 0/608 | 76/0 ± 14/1 | 34/2 ± 16/0 | 20 to 40 years | Bodily pain |
70/0 ± 15/8 | 35/4 ± 13/6 | 40 to 60 years | ||
ANCOVA P-VALUE = 0/144 | 80/0 ± 22/5 | 30/8 ± 18/7 | 20 to 40 years | Emotional well-being |
73/2 ± 22/2 | 27/0 ± 23/8 | 40 to 60 years | ||
ANCOVA P-VALUE = 0/948 | 63/3 ± 29/2 | 30/0 ± 39/9 | 20 to 40 years | Role limitation due to emotional problems |
71/6 ± 29/2 | 18/3 ± 31/5 | 40 to 60 years | ||
ANCOVA P-VALUE = 0/968 | 60/0 ± 23/8 | 31/0 ± 18/0 | 20 to 40 years | Social functioning |
68/0 ± 24/7 | 46/5 ± 20/9 | 40 to 60 years | ||
ANCOVA P-VALUE = 0/473 | 21/0 ± 19/2 | 55/2 ± 22/5 | 20 to 40 years | DHI |
30/6 ± 25/9 | 63/7 ± 25/1 | 40 to 60 years | ||
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Noroozbeygi, A., Dehkordi, M.A., Masoomi, M. et al. Comparing Epley Maneuver, Betahistine, and Dimenhydrinate in the Treatment of Benign Paroxysmal Positional Vertigo: A Prospective Study. Indian J Otolaryngol Head Neck Surg 76, 794–803 (2024). https://doi.org/10.1007/s12070-023-04282-3
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DOI: https://doi.org/10.1007/s12070-023-04282-3