Effect of a Hybrid Maneuver in Treating Posterior Canal Benign Paroxysmal Positional Vertigo

Badawy, Wanees Mohamed; El-Mawla, Ebtessam K Gad; Chedid, Ahmed E F; Mustafa, Ahmed H A

doi:10.3766/jaaa.26.2.4

Cited by 11 publications

(5 citation statements)

References 22 publications

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“…175,[258][259][260] However, 12.8% to 15.3% of patients will require a second CRP, and 5.1% will be classified as treatment failures after 2 CRPs. 175,[258][259][260] If initial therapy fails, the patient should be reassessed for BPPV diagnosis accuracy. Symptoms of CNS disorders may mimic BPPV, and these conditions would not respond to BPPV treatments.…”

Section: Action Statement Profile For Statement 7amentioning

confidence: 99%

“…The most effective treatment for BPPV is CRP. Recent studies have shown that the majority of patients are adequately treated with 1 or 2 CRPs (79.4%‐92.7%) 175,258–260 . However, 12.8% to 15.3% of patients will require a second CRP, and 5.1% will be classified as treatment failures after 2 CRPs 175,258–260 …”

Section: Guideline Key Action Statementsmentioning

confidence: 99%

“…Recent studies have shown that the majority of patients are adequately treated with 1 or 2 CRPs (79.4%-92.7%). 175,[258][259][260] However, 12.8% to 15.3% of patients will require a second CRP, and 5.1% will be classified as treatment failures after 2 CRPs. 175,[258][259][260] If initial therapy fails, the patient should be reassessed for BPPV diagnosis accuracy.…”

Section: Action Statement Profile For Statement 7amentioning

confidence: 99%

See 2 more Smart Citations

Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)

Bhattacharyya¹,

Gubbels

Schwartz

et al. 2017

Otolaryngol.--head neck surg.

585

776

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Objective. This update of a 2008 guideline from the American Academy of Otolaryngology-Head and Neck Surgery Foundation provides evidence-based recommendations to benign paroxysmal positional vertigo (BPPV), defined as a disorder of the inner ear characterized by repeated episodes of positional vertigo. Changes from the prior guideline include a consumer advocate added to the update group; new evidence from 2 clinical practice guidelines, 20 systematic reviews, and 27 randomized controlled trials; enhanced emphasis on patient education and shared decision making; a new algorithm to clarify action statement relationships; and new and expanded recommendations for the diagnosis and management of BPPV.Purpose. The primary purposes of this guideline are to improve the quality of care and outcomes for BPPV by improving the accurate and efficient diagnosis of BPPV, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary testing such as radiographic imaging, and increasing the use of appropriate therapeutic repositioning maneuvers. The guideline is intended for all clinicians who are likely to diagnose and manage patients with BPPV, and it applies to any setting in which BPPV would be identified, monitored, or managed. The target patient for the guideline is aged ≥18 years with a suspected or potential diagnosis of BPPV. The primary outcome considered in this guideline is the resolution of the symptoms associated with BPPV. Secondary outcomes considered include an increased rate of accurate diagnoses of BPPV, a more efficient return to regular activities and work, decreased use of inappropriate medications and unnecessary diagnostic tests, reduction in recurrence of BPPV, and reduction in adverse events associated with undiagnosed or untreated BPPV. Other outcomes considered include minimizing costs in the diagnosis and treatment of BPPV, minimizing potentially unnecessary return physician visits, and maximizing the health-related quality of life of individuals afflicted with BPPV.Action Statements. The update group made strong recommendations that clinicians should (1) diagnose posterior semicircular canal BPPV when vertigo associated with torsional, upbeating nystagmus is provoked by the Dix-Hallpike maneuver, performed by bringing the patient from an upright to supine position with the head turned 45° to one side and neck extended 20° with the affected ear down, and (2) treat, or refer to a clinician who can treat, patients with posterior canal BPPV with a canalith repositioning procedure. The update group made a strong recommendation against postprocedural postural restrictions after canalith repositioning procedure for posterior canal BPPV. The update group made recommendations that the clinician should (1) perform, or refer to a clinician who can perform, a supine roll test to assess for lateral semicircular canal BPPV if the patient has a history compatible with BPPV and the Dix-Hallpike test exhibits horizontal or no nystagmus; (2) differentiate...

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Section: Action Statement Profile For Statement 7amentioning

confidence: 99%

Section: Guideline Key Action Statementsmentioning

confidence: 99%

Section: Action Statement Profile For Statement 7amentioning

confidence: 99%

See 1 more Smart Citation

Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)

Bhattacharyya¹,

Gubbels

Schwartz

et al. 2017

Otolaryngol.--head neck surg.

585

776

View full text Add to dashboard Cite

show abstract

“…Badawy WM et al . [ 20 ] investigated the effect of the GRM with and without post-maneuver instructions and found no difference; they had a very small sample size. This indicates that GRM itself is an effective maneuver therapy, and there is no need for post-maneuver instructions to be given.…”

Section: Discussionmentioning

confidence: 99%

Comparison between Epley and Gans Repositioning Maneuvers for Posterior Canal BPPV: A Randomized Controlled Trial

Joshi

Gyanpuri

Pathak

et al. 2023

Annals of Indian Academy of Neurology

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Objectives: Benign paroxysmal positional vertigo (BPPV) is a condition in which a patient gets severe vertigo on moving his head from one position to another. This study aims at comparing the traditional maneuver-Epley repositioning maneuver (ERM) and the newly emerged maneuver-Gans Repositioning maneuver (GRM). Design: A randomized controlled trial. Settings: Tertiary care teaching University Hospital. Participants: Posterior canal BPPV. Intervention: Two hundred and thirty-four patients with BPPV (PC-BPPV) of the posterior canal, diagnosed using the Dix-hallpike test (DH test), were recruited for the study as per random allocation. Two groups were divided by the random allocation method. One group was treated with the Epley maneuver and the other with Gans maneuver by two separate physiotherapists. Main Outcome Measures: DH test negativity (absence of vertigo and nystagmus), Vertigo Analogue Scale (VAS), and Dizziness Handicap Inventory (DHI). Twenty-four hours post-treatment assessments and data analysis were conducted by another (third) therapist. A one month follow-up subjective assessment was performed. Results: Results of one-variable Chi-square tests revealed significant improvement (P < .0001) in maximum (95%) patients of both groups whether subjects were given GRM or ERM. Also, objective improvement (DH test) was found in the Epley group (n = 118, 82.20%) and the Gans group (n = 116, 78.44%). Patients in both groups improved significantly with no dizziness on the VVAS scale (n = 118, 82.20%) in the Epley group and (n = 116, 78.44%) in the Gans group. Conclusion: GRM is as easy, effective, and safe maneuver as the ERM with the absence of recurrence for the treatment of posterior canal BPPV. Trial Registration: Clinical Trials Registry (CTRI/2019/10/021681).

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“…According to the practice guideline for BPPV (17), we classified betahistine, labyrinthine sedative, and cinnarizine, which were used in the included studies (27)(28)(29), as AVD in this meta-analysis; VR included the Brandt-Daroff exercise, Cawthorne-Cooksey exercises, and home self-treatment (30); and placebo or no treatment was equivalent to the sham maneuver. The Gans repositioning maneuver (GRM), a hybrid of the Semont and Epley maneuvers, is a relatively new treatment maneuver (31). Due to the lack of a treatment-related recurrence rate in some potential eligible studies, these studies were unable to be included in this network meta-analysis.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

Current Therapies in Patients With Posterior Semicircular Canal BPPV, a Systematic Review and Network Meta-analysis

Cheng²,

Yang

et al. 2022

Otology &Amp; Neurotology

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Objective:To compare the efficacy of different treatments for posterior semicircular canal benign paroxysmal positional vertigo (PC-BPPV) by using direct and indirect evidence from existing randomized data.Methods:Randomized case-control studies that compared the efficacy of various nonsurgical treatments in PC-BPPV patients at 1 week and 1 month of follow-up were comprehensively screened. Bayesian network meta-analysis was performed to evaluate direct and indirect treatment comparisons. We further conducted subgroup pairwise meta-analysis to explore the inconsistency between comparisons of the Epley versus a sham maneuver and the Epley versus the Semont maneuver.Results:A total of 41 parallel, randomized controlled studies were included. The Epley with vestibular rehabilitation (EVR), Epley, Semont and Hybrid maneuvers were effective in eliminating nystagmus during a Dix–Hallpike test at 1 week of follow-up (odds ratios [ORs]: 11.41–23.8, 95% credible interval [CrI]: excluding null), among which EVR showed the best efficacy (the surface area under the cumulative ranking curves [SUCRA] = 77.5%). However, at 1 month of follow-up, only the Semont (rank first, SUCRA = 76.1%) and Epley maneuvers (rank second, SUCRA = 65.3%) were effective in eliminating nystagmus during a Dix–Hallpike test. In the pairwise subgroup meta-analysis, for patients younger than 55 years of age, the efficacy of the Epley maneuver was comparable to that of the Semont maneuver [rate ratio (RR): 0.99, 95% confidence interval (CI): 0.93–1.05]; for patients with a longer duration before treatment, the effect of the Epley maneuver was equivalent to that of a sham maneuver (RR: 1.07, 95% CI: 0.90–1.29).Conclusion:Among the 12 types of PC-BPPV treatments, the Epley, Semont, EVR, and Hybrid maneuvers were effective in eliminating nystagmus during a Dix–Hallpike test for PC-BPPV at 1 week of follow-up, whereas only the Epley and Semont maneuvers were effective at 1 month of follow-up. The duration before treatments and the age of patients might contribute to the efficacy of treatments.

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Effect of a Hybrid Maneuver in Treating Posterior Canal Benign Paroxysmal Positional Vertigo

Abstract: We demonstrated that the GRM as a new treatment is effective in treating PC-BPPV with no benefits to postmaneuver restrictions.

Cited by 11 publications

References 22 publications

Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)

Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)

Comparison between Epley and Gans Repositioning Maneuvers for Posterior Canal BPPV: A Randomized Controlled Trial

Current Therapies in Patients With Posterior Semicircular Canal BPPV, a Systematic Review and Network Meta-analysis

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