Effectiveness of Epley's maneuver alone without any drugs in the treatment of posterior canal benign paroxysmal positional vertigo: a prospective analytical study

Authors

  • Josna J. V., M. V. George Department of Otorhinolaryngology, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
  • lhsan A. T. Department of Otorhinolaryngology, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20232520

Keywords:

BPPV, Epley’s maneuver, Vertigo, DHI score, Dix-Hallpike test

Abstract

Background: Posterior canal benign paroxysmal positional vertigo (p-BPPV) is the most common peripheral vestibular problem. Many doctors use three treatment options for p-BPPV: drugs alone, Epley’s maneuver with drugs, and Epley’s maneuver alone. Many studies say that Epley’s maneuver with drugs improves the condition much more effectively than drugs alone. Our study is intended to assess the effectiveness of Epley’s maneuver alone in treating posterior canal BPPV.

Methods: A prospective analytical study was performed on 102 patients who were divided into 2 groups after random sampling. Group I underwent repeated applications of Epley’s maneuver alone, and group II underwent a single Epley’s maneuver along with drugs. The data were collected systematically with the help of a proforma and dizziness handicap inventory (DHI) score chart. The patients were reviewed after 24 hours, 1 week, and 1 month.  

Results: In our study, the mean pre-treatment DHI score of group I was 66.71, and group II was 64.39. After 24 hours, the DHI score came down to 46 and 47.61 respectively, and after 1 week and 1 month, it decreased to 33.06 and 22.86, respectively in group I and group II, it came to 44.71 and 38.78, respectively. The difference in mean DHI score between groups I and II is statistically significant, with each review having a p value of 0.00.

Conclusions: This study was able to demonstrate the efficacy of Epley's maneuver in the treatment of BPPV without any drug.

 

References

Silva C, Amorim AM, Paiva A. Benign paroxysmal positional vertigo–a review of 101 cases. Acta Otorrinolaringologica (English Edition). 2015;66(4):205-9.

Aggarwal NT, Bennett DA, Bienias JL, de Leon CF, Morris MC, Evans DA. The prevalence of dizziness and its association with functional disability in a biracial community population. J Gerontol Series A: Biol Sci Med Sci. 2000;55(5):M288-92.

Mueller M, Strobl R, Jahn K, Linkohr B, Peters A, Grill E. Burden of disability attributable to vertigo and dizziness in the aged: results from the KORA-Age study. Eur J Public Health. 2014;24(5):802-7.

Homøe P, Kværner K, Casey JR, Damoiseaux RA, van Dongen TM, Gunasekera H, et al. Panel 1: epidemiology and diagnosis. Otolaryngol–Head Neck Surg. 2017;156(4):S1-21.

Jung JY, Kim SH. Comparison between objective and subjective benign paroxysmal positional vertigo: clinical features and outcomes. Acta Oto-Laryngologica. 2016;136(12):1267-72.

Narr ME. Reliability of examination data in the diagnosis of benign paroxysmal positional vertigo. Otol Neurotol. 1995;16(6):806-10.

Weider DJ, Ryder CJ, Stram JR. Benign paroxysmal positional vertigo: analysis of 44 cases treated by the canalith repositioning procedure of Epley. Otol Neurotol. 1994;15(3):321-6.

Abdelghaffar H. Effect of canalith repositioning procedures (CRP) in management of subjective benign paroxysmal positional vertigo. J Int Adv Otol. 2010;34-8.

Flood LM. Scott-Brown's Otorhinolaryngology Head and Neck Surgery. Watkinson JC, Clarke RW, editors. Volumes 1–3, 8th edition. CRC Press. 2018.

Jacobson GP, Newman CW. The development of the dizziness handicap inventory. Arch Otolaryngol Head Neck Surg. 1990;116(4):424-7.

Asprella Libonati G. Benign Paroxysmal Positional Vertigo and Positional Vertigo Variants. Int J Otorhinolaryngol Clin. 2012;4(1):25-40

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

Crane BT, Minor LB. Peripheral vestibular disorders. Flint PW, editor. Cummings Otolaryngology, Head and Neck surgery. 6th edition. Philadelphia: Elsevier. 2014.

Hullar TE, Page NC, Minor LB. Vestibular Physiology and Disorders of the Labyrinth. Gulya AJ, Minor LB, Poe DS, editors. Glasscock-Shambaugh Surgery of the ear, 6th edition. USA: Connecticut: People's Medical Publishing House. 2010;128-9.

Hunt WT, Zimmermann EF, Hilton MP. Modifications of the Epley (canalith repositioning) maneuver for posterior canal benign paroxysmal positional vertigo (BPPV). Cochrane Database Syst Rev. 2012;(4):CD008675.

Brevern MV, Radtke A. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry. 2007;78:710-5.

Kaur J, Shamanna K. Management of benign paroxysmal positional vertigo: a comparative study between Epleys manouvre and Betahistine. Int Tinnitus J. 2017;21(1):30-4.

Reinink H, Wegner I, Stegeman I, Grolman W. Rapid systematic review of repeated application of the epley maneuver for treating posterior BPPV. Otolaryngol Head Neck Surg. 2014;151(3):399-406.

Lynn S, Pool A, Rose D, Brey R, Suman V. Randomized trial of the Canalith Repositioning Procedure. Otolaryngol Head Neck Surg. 1995;113:712-20.

Singh G, Aggarwal A, Sahni D, Kumar Sharma D, Yadav V, Bhagat S. Comparative Effectiveness Research: Betahistine add-on Therapy with Epley’s Maneuver Versus Epley’s Maneuver Alone in Treating Posterior BPPV Patients. Indian J Otolaryngol Head Neck Surg. 2022;1-6.

Tevzadze N, Shakarishvili R. Georgian Medical News. 2007;7-8(148-9):403. Available at: http://www.bcbst.com/mpmanual/canalith repositioning.Htm. Accessed on 09 March 2023.

Gordon CR, Gadoth N. Repeated vs single physical maneuver in benign paroxysmal positional vertigo. Acta Neurologica Scandinavica. 2004;110(3):166-9.

Herdman SJ, Tusa RJ. Complications of the canalith repositioning procedure. Arch Otolaryngol Head Neck Surg. 1996;122(3):281-6.

Downloads

Published

2023-08-24

Issue

Section

Original Research Articles