Epley’s maneuver versus brandt-daroff exercise for treatment of unilateral idiopathic BPPV of posterior semicircular canal: a comparative study


  • Muniraju M. Department of Otorhinolaryngology, Dr. B.R. Ambedkar Medical College and Hospital, Bengaluru, Karnataka, India
  • Bhavana Sangoli Department of Otorhinolaryngology, Dr. B.R. Ambedkar Medical College and Hospital, Bengaluru, Karnataka, India




Benign paroxysmal positional vertigo, Brandt-daroff exercise, Dix-hallpike test, Epley’s maneuver


Background: Posterior canal benign paroxysmal positional vertigo (BPPV) is the most common peripheral cause of vertigo. The Dix-hallpike maneuver (DHM) is the gold standard test for diagnosis and elicits a characteristic nystagmus with vertigo at the same time. Several physical treatments have been described for repositioning the displaced otoconial particles. The aim of the study was to determine the differences in the resolution of BPPV on short and on long-term follow-up between epley’s and Brandt-Daroff exercise and to determine whether both exercise may modify the likelihood of recurrence over time.

Methods: Out of 60 patients, 30 underwent Epley’s maneuver and the rest underwent Brandt-Daroff exercise after confirming the posterior canal BPPV on Dix-Hallpike test. Patients were followed weekly until symptom resolution and they become negative on Dix-Hallpike test. The patients were followed for six months and the rates of resolution and the recurrence compared between two groups.

Results: After one week, 70% showed complete resolution of symptoms with none reporting a recurrence after Epley’s maneuver and 46.7% of the Brandt-Daroff exercise. After 6 months the resolution rates and recurrence rates were similar between both the groups with no statistically significant difference.

Conclusions: Epley’s is more effective treatment and as safe as B-D exercise in the short term for BPPV and although it does not reduce the probability of recurrence in the 6 months follow-up period compared with B-D exercise.


Von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T, et al. Epidemiology of benign paroxysmal positional vertigo: a population-based study. J Neurol Neurosurg Psychiatry 2007;78:710-5.

Kumar M, Prasad BK. Vertigo: A spectrum of cases. J surge Forecast 2018;1(1):1013.

Baloh RW, Honrubia V, Jacobson K. Benign positional vertigo: clinical and oculographic features in 240 cases. Neurology. 1987;37:371-8.

Neuhauser HK, Lempert T. Vertigo: epidemiological aspects. Semin Neurol. 2009;29:473-81.

Parnes LS, McClure JA. Free-floating endolymph particles: a new operative finding during posterior semicircular canal occlusion. Laryngoscope 1992;102:988-92.

Schuknecht HF. Cupulolithiasis. Arch Otolaryngol. 1969;90(6):765-78.

Dix MR, Hallpike CS. The pathology symptomatology and diagnosis of certain common disorders of the vestibular system. Proc R Soc Med. 1952;45(6):341-54.

Epley JM. The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 1992;107(3):399-404.

Semont A, Freyss G, Vitte E. Curing the BPPV with a liberatory maneuver. Adv Otorhinolaryngol. 1988;42:290-3.

Brandt T, Daroff RB. Physical therapy for benign paroxysmal positional vertigo. Arch Otolaryngol. 1980;106(8):484-5.

Epley JM. New dimensions of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 1980;88(5):599-605.

Halker RB, Barrs DM, Wellik KE, Wingerchuk DM, Demaerschalk BM. Establishing a diagnosis of benign paroxysmal positional vertigo through the dix-hallpike and side-lying maneuvers: a critically appraised topic. Neurologist. 2008;14(3):201-4.

Cetin YS, Ozmen OA, Demir UL, Kasapoglu F, Basut O, Coskun H. Comparison of the effectiveness of Brandt-Daroff Vestibular training and Epley Canalith repositioning maneuver in benign Paroxysmal positional vertigo long term result: A randomized prospective clinical trial. Pak J Med Sci. 2018;34(3):558-63.

Song MH, Kong TH, Shim DB. Optimal reassessment time for treatment response in posterior canal benign paroxysmal positional vertigo. Laryngoscope. 2020;130(2):496-9.

Karanjai S, Saha AK. Evaluation of vestibular exercises in the management of benign paroxysmal positional vertigo. Indian J Otolaryngol Head Neck Surg. 2010;62(2):202-7.

Parnes LS, Price-Jones RG. Particle repositioning maneuver for benign paroxysmal positional vertigo. Ann Otol Rhinol Laryngol. 1993 May;102(5):325-31.

Brandt T, Huppert D, Hecht J, Karch C, Strupp M. Benign paroxysmal positioning vertigo: a long-term follow-up (6-17 years) of 125 patients. Acta Otolaryngol. 2006;126(2):160-3.

Von Brevern M, Seelig T, Radtke A. Short-term efficacy of Epley’s manoeuvre: a double-blind randomised trial. J Neurol Neurosurg Psychiatry 2006;77:980-2.

Amor-Dorado JC, Barreira-Fernández MP, Aran-Gonzalez I, Casariego-Vales E, Llorca J, González-Gay MA. Particle repositioning maneuver versus Brandt-Daroff exercise for treatment of unilateral idiopathic BPPV of the posterior semicircular canal: a randomized prospective clinical trial with short- and long-term outcome. Otol Neurotol. 2012;33(8):1401-7.

Nunez RA, Cass SP, Furman JM. Short- and long-term outcomes of canalith repositioning for benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2000 May;122(5):647-52.

Kansu L, Avci S, Yilmaz I, Ozluoglu LN. Long-term follow-up of patients with posterior canal benign paroxysmal positional vertigo. Acta Otolaryngol 2010;130(9):1009-12.

Cohen HS, Kimball KT. Effectiveness of treatments for benign paroxysmal positional vertigo of the posterior canal. Otol Neurotol. 2005;26(5):1034-40.

Radtke A, von Brevern M, Tiel-Wilck K, et al. Self-treatment of benign paroxysmal positional vertigo: Semont maneuver vs Epley procedure. Neurology, 2004;63:150-2.






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