Betahistine add-on therapy for treatment of subjects with posterior benign paroxysmal positional vertigo: a randomized controlled trial

Sayın, İbrahim; Koç, Recep Haydar; Temirbekov, Dastan; Güneş, Selçuk; Çırak, Musa; Yazıcı, Zahide Mine

doi:10.1016/j.bjorl.2020.07.011

Cited by 18 publications

(10 citation statements)

References 19 publications

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“…In contrast, our research is the biggest randomized controlled trial to date examining the role of medicine in the management of persistent symptoms. We found that the participants in the (vestibular suppressor) group developed good effects of Epley's maneuvers than those in the no-medication group 23 . Also, dizziness was greatly reduced in those using vestibular suppressants.…”

Section: Discussionmentioning

confidence: 69%

Role of Vestibular Suppressants (B. Histine, Cinnarizine, Meclizine) after Successful Epley’s Maneuvers in Benign Paroxysmal Positional Vertigo

Tahir¹,

Fareed²,

Hakim³

et al. 2023

PJMHS

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Background: Benign positional paroxysmal vertigo (BPPV) is one of the most prevalent causes of dizziness, affecting between 11 and 64 people per 100,000 each year and 2.4% of the population overall. Vestibular suppressants have been shown in recent studies to be effective in reducing residual symptoms after a successful Epley’s maneuvers, however to the best of our knowledge, very few research have analyzed the features of residual symptoms in BPPV patients following Epley’s maneuvers. There has been no definitive research on what causes symptoms duration, canal involvement, cumulative successful ratee, residual symptoms and dysregulation are among possibilities put up to explain the phenomenon. Objective: This research focused on role of vestibular suppressants including B.histine, cinnarizine, and meclizine after successful Epley’s maneuvers in benign paroxysmal positional vertigo Study Design: Cross-sectional study Study Setting: The study was conducted at department of ENT CMH, Multan from 01 January 2022 to 30th October 2022. Methodology: Total 135 patients were divided into two groups. In group A 60 patients were taking vestibular suppressants and in group B 75 patients were not taking any drugs, both groups had successful Epley’s maneuvers in benign paroxysmal positional vertigo Patients were considered for inclusion if they had idiopathic BPPV. A single doctor made the BPPV diagnosis after examining a patient's history and doing a hall pike test. The patients' symptoms duration, canal, cumulative success rate and residual symptoms were measured immediately after treatment, and two weeks. The statistical analysis was done by using SPSS version 20. Results: In group A out of which 24 were taking B.histine, 26 were taking cinnarizine, and 25 were taking meclizine as vestibular suppressants. In group B, 75 participants after successful Epley’s maneuver were not taking any vestibular suppressants. In this study there is 29 males and 31 females in group A and 37 males and 38 females in group B. Interestingly, the success rate with one treatment cycle was higher in the group A (p = 0.001). Further analysis of outcomes showed the residual symptoms in patients with a short (≤4 days) symptom duration revealed a correlation with the successful Epley’s maneuver in group A. Practical Implication: Vestibular suppressants have been standard practice in most hospitals for the treatment of severe vertigo for decades. Vertigo caused by vestibular imbalance can be treated with vestibular suppressants. When Epley's Maneuvers have been performed successfully in patients with BPPV, the efficacy of Vestibular Suppressants (B.Histine, Cinnarizine, Meclizine) has not been conclusively established. So, their role must be studied. Conclusion: Finally, we found that patients who used anti-vestibular suppression medication following an Epley's technique for treating and controlling BPPV symptoms fared better than those who did not. We advise the Epley method for BPPV therapy with the maintenance of suppressants for the better management. Keywords: B.histine, cinnarizine, meclizine, Epley’s maneuvers, paroxysmal positional virtigo

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Section: Discussionmentioning

confidence: 69%

Role of Vestibular Suppressants (B. Histine, Cinnarizine, Meclizine) after Successful Epley’s Maneuvers in Benign Paroxysmal Positional Vertigo

Tahir¹,

Fareed²,

Hakim³

et al. 2023

PJMHS

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“…Six articles [ 13 , 14 , 17 – 19 , 21 ] assessed the efficacy rate after treatment. The randomized-effects model analysis showed no significant difference was observed in efficiency rate between the 2 groups (RR = 1.07, 95% CI 0.99–1.16, P = .092) (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Five studies [13,[15][16][17]19] reported DHI score after treatment. The randomized-effects model was adopted, because of the significant heterogeneity (I 2 = 66.4%, P = .018).…”

Section: Dhi Scorementioning

confidence: 99%

“…3 articles were further excluded for the following reasons: not reported relevant data (n = 2); the participants were not diagnosed with PC-BPPV (n = 1). Finally, a total of 9 studies [13][14][15][16][17][18][19][20][21] with 860 PC-BPPV patients were finally included in the meta-analysis, in which 432 were treated with Epley's maneuver + betahistine, and 428 received Epley's maneuver alone. Studies were conducted in Turkey, Iran, Pakistan, and China (Table 1).…”

Section: Characterization Of the Selected Studiesmentioning

confidence: 99%

“…According to the Cochrane evaluation system, one study [15] did not mention random sequence generation, 3 studies [18][19][20] did not mention the method of random sequence generation. Seven studies [14][15][16][17][18][19][20] didn't report allocation concealment, blinding of participants and personnel, and blinding of outcome assessment. Two studies [13,21] were double-blind, randomized, controlled clinical trials.…”

Section: Quality Assessment Of the Selected Studiesmentioning

confidence: 99%

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Efficacy of Epley’s maneuver plus betahistine in the management of PC-BPPV: A systematic review and meta-analysis

Sun

Zhao

et al. 2023

Medicine

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Background: To evaluate the efficacy of Epley’s maneuver plus betahistine in the management of patients with posterior canal benign paroxysmal positional vertigo (PC-BPPV). Methods: Electronic databases including PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, and Wanfang were searched from their inception to April, 2022. The effect size was analyzed by calculating the pooled risk ratio estimates of efficacy rate, recurrence rate, and standardized mean differences (SMD) of dizziness handicap inventory (DHI) score with a 95% confidence interval (CI). Sensitive analysis was performed simultaneously. Results: A total of 9 randomized controlled trials with 860 PC-BPPV patients were included in the meta-analysis, in which 432 were treated with Epley’s maneuver plus betahistine, and 428 received Epley’s maneuver alone. The meta-analysis revealed that Epley’s maneuver plus betahistine significantly improved DHI score than Epley’s maneuver alone (SMD = −0.61, 95% CI −0.96 to −0.26, P = .001). In addition, both Epley’s maneuver plus betahistine and Epley’s maneuver groups had comparable outcomes in efficacy rate and recurrence rate. Conclusion: This meta-analysis shows that Epley’s maneuver plus betahistine in PC-BPPV patients had favorable effects on DHI score.

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Comparative Effectiveness Research: Betahistine add-on Therapy with Epley’s Manoeuvre Versus Epley’s Manoeuvre Alone in Treating Posterior BPPV Patients

Singh

Aggarwal

Sahni

et al. 2022

Indian J Otolaryngol Head Neck Surg

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Betahistine add-on therapy for treatment of subjects with posterior benign paroxysmal positional vertigo: a randomized controlled trial

Cited by 18 publications

References 19 publications

Role of Vestibular Suppressants (B. Histine, Cinnarizine, Meclizine) after Successful Epley’s Maneuvers in Benign Paroxysmal Positional Vertigo

Role of Vestibular Suppressants (B. Histine, Cinnarizine, Meclizine) after Successful Epley’s Maneuvers in Benign Paroxysmal Positional Vertigo

Efficacy of Epley’s maneuver plus betahistine in the management of PC-BPPV: A systematic review and meta-analysis

Comparative Effectiveness Research: Betahistine add-on Therapy with Epley’s Manoeuvre Versus Epley’s Manoeuvre Alone in Treating Posterior BPPV Patients

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