Risk factors for poor outcome of a single Epley maneuver and residual positional vertigo in patients with benign paroxysmal positional vertigo

Abstract

The negative rates of the Dix-Hallpike test on day 7 after a single Epley maneuver in both patients with P-BPPV secondary to head trauma (25%) and those with prolonged bedrest (36%) were significantly lower than that (73%) in patients with idiopathic P-BPPV. Additionally, the remission of residual positional vertigo in the former groups of patients was significantly delayed in comparison with that of the latter group. However, there were no significant differences in the efficacy of a single Epley maneuver and persistent residual positional vertigo between idiopathic P-BPPV and P-BPPV secondary to inner ear disease.

Idiopathic benign paroxysmal positional vertigo in the elderly: a long-term follow-up study

“…This is consistent with previous studies, but the proportion of horizontal canal involvement is much higher than those studies [8,14,15,20]. Possible explanations for this result are as follows.…”

“…BPPV is characterized by short-standing episodes of vertigo which triggered by a change in head position [10][11][12]. It is believed that dislodged otoconia from the utricle falls into the semicircular canal; the otoconia, then shift position with head movement, provoking vertigo and nystagmus [11,13,14]. The diagnosis of BPPV is relative and easily established by relevant patient history and by detecting nystagmus elicited by either the Dix-Hallpike maneuver or the supine headroll test at the outpatient clinic [8,9,12].…”

“…Results The gender, numbers of CRM for successful treatment, affected semicircular canal, and the 1-and 5-year recurrence proportion showed no statistically significant difference between two groups (p > 0.05). The only exception was the experimental group which took a longer treatment comprises canalolith repositioning maneuvers, which are simple and effective in curing BPPV [11,14,15].…”

Long-term outcome of vertigo and dizziness associated disorders following treatment in specialized tertiary care: the Dizziness and Vertigo Registry (DiVeR) Study

“…Most studies on BPPV concentrated on acute treatment with different manoeuvres and report a good efficacy of BPPV treatment within the first week [14]. Spontaneous remission within the first month is also considerably high with over 70 % [15]. However, recurrence rates within the first month range between 10 and 16 % and increase to over 50 % over 1 year [12].…”

Neuro-otology- some recent clinical advances

“…A single Epley maneuver has a success rate of up to 80 % [13, 14]; the success rate increases to over 90 % with four repetitions on the same day. Previous head trauma and prolonged bedrest are risk factors for a poor outcome after a single Epley maneuver, while BPV secondary to some inner ear disease is not [15]. After a simple maneuver, in which the subject first lies supine for 3 min, then on the unaffected shoulder for some hours, the success rate is 89 % after 1 week and 100 % after 2 weeks [16].…”