A Comparison of Two Home Exercises for Benign Positional Vertigo: Half Somersault versus Epley Maneuver

Abstract

Benign paroxysmal positional vertigo (BPPV) frequently recurs after treatment, so a home exercise would be desirable. We designed a self-administered exercise, the half somersault, for home use. In this randomized single-blind study, we compare the efficacy of our exercise to self-administered Epley maneuvers in patients with BPPV. Subjects performed exercises twice while observed, were re-tested with the Dix Hallpike, and then reported on exercise use for 6 months. Outcome measures were the reduction of nystagmus intensity, tolerability of induced dizziness, and long-term efficacy. Both exercises resulted in a significant reduction in nystagmus after two self-applications. The Epley maneuver was significantly more efficacious in reducing nystagmus initially, but caused significantly more dizziness during application than the half somersault. During the 6-month follow-up, the Epley group had significantly more treatment failures than the half somersault group. We believe that both exercises can be self-applied to control symptoms, but the half somersault is tolerated better and has fewer side effects as a home exercise.

Comparing the Effects of Epley Maneuver and Cinnarizine on Benign Positional Paroxysmal Vertigo; A Randomized Clinical Trial

“…They have also presented “Half somersault” exercise as a more resistant maneuver than Epley with less complications. The six-month follow up time has made their study distinguished [ 20 ]. Maslovara et al .…”

Comparing the Effects of Epley Maneuver and Cinnarizine on Benign Positional Paroxysmal Vertigo: A Randomized Clinical Trial

“…They have also presented "Half somersault" exercise as a more resistant maneuver than Epley with less complications. The six-month follow up time has made their study distinguished [20]. [25].…”

The Efficacy of the Half Somersault Maneuver in Comparison to the Epley Maneuver in Patients with Benign Paroxysmal Positional Vertigo

“… 6 To treat PC-BPPV, the Epley and Semont maneuvers are commonly used, with nearly similar success rates. 7 The Epley maneuver (EM) as a CRP is most used to treat PC-BPPV for an effective outcome. 8 Even though the EM can remove the particles successfully, it may be associated with mild but negative outcomes such as fainting and nausea as well as a change to horizontal canal BPPV.…”

“… 9 Foster et al (2012) proposed another treatment called Half Somersault Maneuver (HSM) that can clear the detached particles from the posterior semicircular canal, with fewer side effects. 7 According to Foster (2012), the first stage in performing the EM is similar to the Dix Hallpike (DH) maneuver and causes ampullofugal movements that contribute to the sensation of vertigo and nystagmus which may be severe enough to induce uncomfortable symptoms such as vomiting. Conversely, in the initial step of the HSM, the particle movement is against the direction of fluid movement and has an inhibitory effect (ampullopetal movement).…”

“…However, induced dizziness during the HSM was remarkably lower compared to the EM, and treatment failure was more frequent in the EM. 7 In another study, Paramasivan Mani et al (2019) used the Dizziness Handicap Inventory (DHI) questionnaire to compare the effectiveness of the EM and HSM with the Brandt–Daroff exercise in patients with PC-BPPV and showed greater success in reducing the perceived handicap by self-application of HSM with the Brandt–Daroff exercise. 10 Moreover, home-based treatment is a cost-effective and time-saving approach to recommend for patients with recurrent or continued BPPV who need additional maneuvers after the first clinical-based intervention.…”