Effect of the Epley Maneuver and Brandt-Daroff Exercise on Benign Paroxysmal Positional Vertigo Involving the Posterior Semicircular Canal Cupulolithiasis: A Randomized Clinical Trial

Abstract

Objective: To investigate the therapeutic efficacies of the Epley maneuver and Brandt-Daroff (BD) exercise in patients with benign paroxysmal positional vertigo involving the posterior semicircular canal cupulolithiasis (PC-BPPV-cu).Methods: We conducted a randomized clinical trial to evaluate the therapeutic effect of the Epley maneuver and BD exercise in patients with PC-BPPV-cu. Patients were randomly assigned to undergo the Epley maneuver (n = 29) or BD exercise (n = 33). The primary outcome was an immediate resolution of positional nystagmus within 1 h after a single treatment of each maneuver on the visit day. Secondary outcomes included the resolution of positional nystagmus at 1 week, the change of maximal slow phase velocity (mSPV) of positional nystagmus, and dizziness handicap inventory (DHI) immediately and at 1 week.Results: Immediate resolution occurred in none of 29 patients in the Epley maneuver group and only 1 of 33 patients in the BD exercise group. The Epley maneuver and BD exercise had an equivalent effect at 1 week in treating PC-BPPV-cu in terms of resolving positional nystagmus (48 vs. 36%, p = 0.436) and the decrease of mSPV and DHI.Conclusion: Neither the Epley maneuver nor BD exercise has an immediate therapeutic effect in treating PC-BPPV-cu. Clear classification of PC-BPPV should be required at the time of different pathology and different treatment response.

Posterior canal benign paroxysmal positional vertigo with long duration: Heavy or light cupula?

“…The incidence of PSCC BPPV cupulolithiasis is considered much lower than that of canalolithiasis, and the proportion of cupulolithiasis cases in PSCC BPPV has been reported to be 6.4%–7.2%, 6,8 consistent with the proportion of 5.1% in the present study. Although many studies have supported the efficacy of canalith repositioning maneuvers (CRMs) in PSCC BPPV canalolithiasis, immediate resolution of BPPV after CRMs was not achieved in any of the patients with PSCC BPPV cupulolithiasis 9,22 . Despite the lack of immediate efficacy of CRMs, the long‐term prognosis is good in most cases 4,5 …”

“…BPPV cupulolithiasis. 9,22 Despite the lack of immediate efficacy of CRMs, the long-term prognosis is good in most cases. 4,5 Ichijo examined the difference between positional nystagmus in the head-hanging position and that in the nose-down position to confirm the validity of Ewald's third law in patients with PSCC BPPV cupulolithiasis fulfilling the following conditions with PSCC BPPV cupulolithiasis, although this law has been well supported in cases with canalolithiasis.…”

Efficacy of the Head Rotation Test With Bowing for the Lateral Canal Benign Paroxysmal Positional vertigo

“…We documented the peak SPV of positional nystagmus to compare the nystagmus intensity in each positioning test (14)(15)(16). The peak SPV was obtained by averaging the SPVs of five consecutive nystagmus beats around its maximum.…”

Effects of Half-Somersault and Brandt-Daroff exercise on dizziness, fear of fall and quality of life in patients with posterior canal benign paroxysmal positional vertigo: a randomised control trial

“…(4) As a matter of fact, this condition is associated with little spells of vertigo on moving the head, causing the person to feel dreaded with respect to head developments and, hence, limit their everyday life out of fear of increasing the risk of falls. (5) There are different ways to treat PC-BPPV, including Epley's Manoeuver (Canal repositioning), Brandt-Daroff work out (Habituation work out), and Half-Somersault Manoeuvre (Head position activities) and literature confirms that these manoeuvres achieve the Central Nervous System (CNS) adaptation and compensation. (6) A number of studies have been done on different manoeuvres, but no study is available to-date which compares these manoeuvres, i.e.…”