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

Abstract

Objectives. Canalolithiasis of the posterior semicircular canal (PC) is the most common reason for benign paroxysmal positional vertigo (BPPV). If a patient is diagnosed with PC-BPPV through the Dix-Hallpike test, the modified Epley maneuver (mEpley) is used as the gold standard treatment. To reduce the discomfort of the standard mEpley, we proposed placing a pillow under the shoulders during this therapeutic maneuver. The purpose of this study was to determine whether the therapeutic efficacy of the mEpley with a pillow under the shoulders (mEpley-PS) was comparable to that of the standard mEpley.Methods. A randomized controlled study at three academic referral hospitals was conducted in compliance with the CONSORT statement. Patients who were diagnosed with PC-BPPV through the Dix-Hallpike test were randomly assigned to groups A or B. Patients in groups A and B were treated with the standard mEpley and mEpley-PS, respectively. The resolution of vertigo and nystagmus on the Dix-Hallpike test at a 1-week follow-up after treatment was the main outcome measurement to assess the efficacy of treatment.Results. Forty-one patients diagnosed with PC-BPPV were enrolled in this study. Twenty-one patients were assigned to group A and 20 were assigned to group B. The success rate at 1 week after treatment was 85.7% in group A and 80.0% in group B. There was no statistically significant difference between the two groups (<i>P</i>=0.697).Conclusion. The therapeutic efficacy of the mEpley-PS was comparable to that of the standard mEpley. The use of the pillow modification may be an excellent alternative if a patient cannot tolerate the head-hanging position, and it is helpful for patients who have anxiety about the head-hanging position. The mEpley-PS can be performed on a bed with or without a headboard. It is both a patient-friendly and a clinician-friendly maneuver.

The Semont-Plus Maneuver or the Epley Maneuver in Posterior Canal Benign Paroxysmal Positional Vertigo

“…The EM requires the supine patient’s head and trunk to be rotated after being tilted backward into a slightly head-hanging position with a pillow under the patient’s shoulder to reduce the discomfort . The success rate can be improved by repeating the maneuver 2 to 3 times in 1 session …”

Treatment of Benign Paroxysmal Positional Vertigo: An Approach Considering Patients’ Convenience

“…Recently, some authors reported that a modified version of the DHT with a pillow under the shoulders to resolve patients’ discomfort during the standard DHT had the same diagnostic effectiveness as the standard DHT [ 5 ]. Following the previous report, the authors reported that the therapeutic efficacy of the modified Epley maneuver with a pillow under the shoulders was also comparable to that of the standard modified Epley maneuver [ 6 ]. The authors also stated that this modified method can be helpful for patients who have anxiety about the head-hanging position during treatment and can reduce both the force needed and the physical burden on clinicians because they no longer need to hold onto the patient’s head.…”

“…However, the study of Lee et al [6] had some limitations: (1) no evaluation of patients' subjective discomfort, (2) a relatively small population, and (3) a short-term follow-up period. In addition, if the size of the pillow is not chosen depending on the size of the patient's body, the patient may not be positioned properly for treatment.…”

Association between Benign Paroxysmal Positional Vertigo and Previous Proton Pump Inhibitor Use: A Nested Case–Control Study Using a National Health Screening Cohort

“…BPPV is a common peripheral vestibular disorder whose prevalence is predicted to be approximately 2.4% [ 12 ]. The pathophysiology of BPPV has been attributed to otoconia dislocated from otolith organs, which perturb the endolymphatic flow in the semicircular canals according to head position [ 13 , 14 ]. Therefore, inner ear dysfunctions, for instance, the disturbance of endolymphatic homeostasis or degenerative insults of otoconia, can induce BPPV.…”