Rapid Systematic Review of Repeated Application of the Epley Maneuver for Treating Posterior BPPV

Reinink, Hendrik; Wegner, Inge; Stegeman, Inge; Grolman, Wilko

doi:10.1177/0194599814536530

Cited by 36 publications

(35 citation statements)

References 41 publications

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“…Over 80% of cases were free from positional nystagmus after a single treatment which is also in line with 68–90% success rates with the global single-cycle treatment experience (26). Interestingly, we noted a significantly higher success rate with single-cycle treatment in the CND group.…”

Section: Discussionsupporting

confidence: 73%

Efficacy of Repositioning Therapy in Patients With Benign Paroxysmal Positional Vertigo and Preexisting Central Neurologic Disorders

et al. 2018

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With the exception of migraines, benign paroxysmal positional vertigo (BPPV) in patients with preexisting central neurologic disorders (CND) is rarely discussed in the literature. Demographic features of this patient group and the efficacy of repositioning therapy are still unknown. We hypothesized that a CND may alter the function of the central vestibular pathway, thus changing the pattern of BPPV and outcomes of repositioning. In this study, we enrolled 93 consecutive idiopathic BPPV patients and categorized them into two groups according to the presence or absence of a CND. In our series, 31.2% of BPPV cases had a CND. The most common associated CNDs were cerebrovascular disease and migraines. The two groups showed similar age distributions, canal involvement, success rates of repositioning, and cycles of treatment used to achieve complete resolution. The major differences were the proportion of females (89.7%) and a right-side predominance (75.9%) in the CND group. There was a trend of more residual dizziness (RD) after successful repositioning in the CND group, but the difference was not significant. The reason for the female and right-side predominance in the CND group is unclear. We concluded that the efficacy of repositioning therapy was excellent (with a success rate of 80.6% with one cycle and 93.5% within two cycles of treatment) for BPPV with or without a preexisting CND. Clinicians are encouraged to diagnose and treat BPPV in patients with a preexisting CND as early as possible to improve patients' quality of life, avoid complications, and reduce medical costs.

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Section: Discussionsupporting

confidence: 73%

Efficacy of Repositioning Therapy in Patients With Benign Paroxysmal Positional Vertigo and Preexisting Central Neurologic Disorders

et al. 2018

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“…Recently, a systematic review of repeated application of the Epley maneuver for treating posterior canal BPPV indicated that application of multiple maneuvers per session showed better results compared with application of a single maneuver per session. Multiple maneuvers per session might accelerate the clearance of canaliths from the semicircular canal, as suggested by a higher percentage of successful earlier sessions when using multiple maneuvers per session (24). In our study, only a single CMRM or RM was applied in each session where the single RM consisted of one 360-degree rotation, and a single CMRM consisted of three sequential 360-degree rotations with individual patterns.…”

Section: Discussionmentioning

confidence: 76%

Efficacy of Computer-Controlled and Modified Roll Maneuver for Treatment of Geotropic Lateral Canal Benign Paroxysmal Positional Vertigo

Shan

Peng

Wang³

2015

Otology &Amp; Neurotology

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“…The rate of successful treatment of BPPV reaches 90% to 98% when additional repositioning maneuvers are subsequently performed. 186,274,275 Therefore, the CRPs are the treatment of choice for initial BPPV treatment failures deemed to be due to persistent BPPV. For treatment failures refractory to multiple CRP, surgical plugging of the involved posterior semicircular canal or singular neurectomy has a >96% success rate; however, the quality of data supporting these interventions precludes the ability to make definitive recommendations for their utilization.…”

Section: Statement 7b Evaluation Of Treatmentmentioning

confidence: 99%

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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Rapid Systematic Review of Repeated Application of the Epley Maneuver for Treating Posterior BPPV

Abstract: Multiple studies with moderate RoB show a beneficial effect of multiple sessions of the Epley maneuver in p-BPPV patients who are not fully cleared of symptoms after the first session.

Cited by 36 publications

References 41 publications

Efficacy of Repositioning Therapy in Patients With Benign Paroxysmal Positional Vertigo and Preexisting Central Neurologic Disorders

Efficacy of Repositioning Therapy in Patients With Benign Paroxysmal Positional Vertigo and Preexisting Central Neurologic Disorders

Efficacy of Computer-Controlled and Modified Roll Maneuver for Treatment of Geotropic Lateral Canal Benign Paroxysmal Positional Vertigo

Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)

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