Clinical Question

Is the Epley maneuver effective for the long-term control of symptoms in patients with benign paroxysmal positional vertigo?

Bottom Line

How often do patients walk into our offices with a problem and walk out cured? The Epley maneuver, which is not particularly difficult to do, results in the long-term (at least one year) resolution of posterior canal benign paroxysmal positional vertigo. A video of the maneuver can be found at http://tinyurl.com/epleyman. (Level of Evidence = 1b)

Synopsis

These investigators enrolled 44 patients with posterior benign paroxysmal positional vertigo for at least one month confirmed by the Dix-Hallpike test. The patients were randomly assigned (concealed allocation unknown) to receive the Epley maneuver without premedication or a sham procedure of moving the head around. The Dix-Hallpike test was repeated and the maneuver (sham or Epley) was repeated up to two more times if the test result was still positive. Patients were asked to sleep semi-upright and to avoid sleeping on the affected side for the next two nights. Patients were retested at one, three, six, and 12 months, at which time they also completed the Dizziness Handicap Inventory. In the Epley maneuver group, 20 of 22 patients (91%) had long-term success (defined as a negative Dix-Hallpike result and a Dizziness Handicap Inventory score of 0) compared with 10 of 22 patients (46%) in the sham treatment group (P = .003). No patients converted to horizontal canal benign paroxysmal positional vertigo.

Study design: Randomized controlled trial (double-blinded)

Funding source: Self-funded or unfunded

Allocation: Uncertain

Setting: Outpatient (specialty)

Reference: BruintjesTDCompanjenJvan der Zaag-LoonenHJvan BenthemPPA randomised sham-controlled trial to assess the long-term effect of the Epley manoeuvre for treatment of posterior canal benign paroxysmal positional vertigo. Clin Otolaryngol2014; 39( 1): 39– 44.