Analysis of risk factors influencing the outcome of the Epley maneuver

Abstract

Benign paroxysmal positional vertigo (BPPV) is the most frequent type of vertigo. The treatment of canalithiasis of the posterior semicircular canal consists in performing a particle-repositioning maneuver, such as the Epley maneuver (EM). However, the EM is not effective in all cases. The objective of this study is to identify risk factors, which predict the EM failure, among the clinical variables recorded in anamnesis and patient examination. This is an observational prospective multicentric study. All patients presenting with BPPV were recruited and applied the EM and appointed for a follow-up visit 7 days later. The following variables were recorded: sex, age, arterial hypertension, diabetes, hyperlipidemia, smoking habit, alcohol consumption, migraine, osteoporosis, diseases of the inner ear, previous ipsilateral BPPV, previous traumatic brain injury, previous sudden head deceleration, time of evolution, sulpiride or betahistine treatment, experienced symptoms, outcome of the Halmagyi maneuver, laterality, cephalic hyperextension of the neck, intensity of nystagmus, intensity of vertigo, duration of nystagmus, occurrence of orthotropic nystagmus, symptoms immediately after the EM, postural restrictions, and symptoms 7 days after the EM. Significant differences in the rate of loss of nystagmus were found for six variables: hyperlipidemia, previous ipsilateral BPPV, intensity of nystagmus, duration of nystagmus, post-maneuver sweating, and subjective status. The most useful significant variables in the clinical practice to predict the success of the EM are previous BPPV and intensity of nystagmus. In the other significant variables, no physiopathological hypothesis can be formulated or differences between groups are too small.

Effect of age on treatment outcomes in benign paroxysmal positional vertigo: A systematic review

“…Of the six articles without numeric age‐group data, five studies found no influence of age on treatment outcome after one CRP 24,29,37,42,61 . Korres et al 51 found a better initial response to treatment in the younger age group ( p < 0.001) 51 …”

Association between Dix-Hallpike test parameters and successful repositioning maneuver in posterior semicircular canal benign paroxysmal positional vertigo: a case-control study

“…However, other studies have shown a negative correlation between osteoporosis/vitamin D deficiency and BPPV (9). Other studies investigating the role of other prognostic factors, such as arteriosclerotic turn over (10), prior trauma or labyrinthitis (11), previous BPPV history, and intensity of nystagmus (12) predicted a low correlation for BPPV outcomes. Furthermore, abnormal vestibular evoked myogenic potentials (VEMPs), as neurophysiological parameters, showed a chronic and resistive BPPV prognosis (13), while vertigo occurring immediately after a maneuver as a liberator sign, correlated with the success of treatment (14).…”

Risk Factors for Positional Vertigo and the Impact of Vertigo on Daily Life: The Korean National Health and Nutrition Examination Survey

“…Some studies have reported associations between hyperlipidemia and PV [18-20]. Hyperlipidemia can cause vascular damage to the inner ear [21,22].…”