Physical and Emotional Burden of the Epley Maneuver in the Elderly

Abstract

Objective: To analyze and compare experiences of anxiety and discomfort caused by the Epley maneuver and the willingness for a potential retreatment between younger (≤70 yr) and older (>70 yr) patients. Study Design: Prospective, observational cohort study. Setting: Tertiary referral center. Methods: Dutch adults, diagnosed with posterior canal benign paroxysmal positional vertigo, were included. Patients with dementia or subjected to an Epley maneuver ≤4 months before the hospital visit were excluded. Patients were asked about their experiences with the Epley maneuver directly after the maneuver, after 2 weeks and after 2 months. Differences in experiences between the age groups were tested with the Fisher's exact test and subgroup analyses were performed using multivariable logistic regression. Results: Out of 179 included patients, 115 (64%) were aged ≤70 and 134 (75%) were female. In both groups, 25% reported anxiety directly after the Epley maneuver. Two weeks later, 19 and 27%, respectively (p = 0.26) reported anxiety. In the young group, 30% expressed discomfort directly after treatment compared with 45% in the elderly (OR 1.98, 95% CI 1.05–3.75, p = 0.04). Two weeks later, this was 36 and 38%, respectively (p = 0.87). This decreased to 24 and 33%, respectively (p = 0.37), after 2 months. There was no significant difference in willingness for potential retreatment between both groups after 2 weeks (93 and 95%, respectively, p = 0.75) nor after 2 months (97 and 92%, respectively, p = 0.13). Conclusion: The Epley maneuver results in little anxiety and discomfort both in young and in elderly patients. Most patients show willingness for potential retreatment in case symptoms recur.

The influence of cerebral small vessel diseases on the efficacy of repositioning therapy and prognosis of benign paroxysmal positional vertigo

“…The vestibular function of elderly patients suffers from age-related decline 36 , 42 . In addition, elderly patients are more likely to develop anxiety, which has also been shown to promote occurrence of RD 5 , 42 . Cha et al found that brain atrophy was related to long-lasting dizziness after BPPV treatment and speculated that there may be a relationship between brain atrophy and otoneurologic diseases 12 .…”

“…Most BPPV patients do not think that it is a malignant due to its name, but it can have a serious impact on patients' daily activities. BPPV can have a huge impact on patient's quality of life, and is closely related to patients' anxiety and depression, due to an increased risk of falls 2 , 4 , 5 .…”

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

“…25,28,59 Maas et al reported that, specifically in older adults, nausea could indeed be a side effect of the Epley maneuver in the first days post-treatment. 62 Potential explanations for age differences in BPPV treatment success Despite the fact that BPPV is the most common vestibular disorder, it has a low recognition rate in primary health care, particularly in older adults. 4,8,63 Older adults report disequilibrium or imbalance as the clinical presentation of BPPV, without reporting vertigo.…”

Therapeutic Efficacy of the Modified Epley Maneuver With a Pillow Under the Shoulders

“…However, several side effects related to the standard mEpley have been reported, such as a falling sensation, anxiety, and discomfort [10]. According to a clinical practice guideline, minor side effects such as nausea or imbalance may be associated with the standard mEpley, and these side effects might lead patients to be hesitant to undergo repeated maneuvers and an extended treatment period [11]. From the clinician's standpoint, rotating the patient's head below the table while holding it in the air is strenuous and can fatigue the clinician's arms and back.…”