Effect of Repositioning Maneuver Type and Postmaneuver Restrictions on Vertigo and Dizziness in Benign Positional Paroxysmal Vertigo

Michel Toupet,Alexis Bozorg Grayeli,Evelyne Ferrary

doi:10.1100/2012/162123

Abstract

Introduction. To compare the efficiency of Epley (Ep) and Sémont-Toupet (ST) repositioning maneuvers and to evaluate postmaneuver restriction effect on short-term vertigo and dizziness after repositioning maneuvers by an analog visual scale (VAS) in benign positional paroxysmal vertigo (BPPV). Material and Methods. 226 consecutive adult patients with posterior canal BPPV were included. Patients were randomized into 2 different maneuver sequence groups (n = 113): 2 ST then 1 Ep or 2 Ep then 1 ST. Each group of sequence was randomized into 2 subgroups: with or without postmaneuver restrictions. Vertigo and dizziness were assessed from days 0 to 5 by VAS. Results. There was no difference between vertigo scores between Ep and ST groups. Dizziness scores were higher in Ep group during the first 3 days but became similar to those of ST group at days 4 and 5. ST maneuvers induced liberatory signs more frequently than Ep (58% versus 42% resp., P < 0.01, Fisher's test). After repositioning maneuvers, VAS scores decreased similarly in patients with and without liberatory signs. Postmaneuver restrictions did not influence VAS scores. Conclusion. Even if ST showed a higher rate of liberatory signs than Ep in this series, VAS scores were not influenced by these signs.

Highlights

To compare the efficiency of Epley (Ep) and Semont-Toupet (ST) repositioning maneuvers and to evaluate postmaneuver restriction effect on short-term vertigo and dizziness after repositioning maneuvers by an analog visual scale (VAS) in benign positional paroxysmal vertigo (BPPV)
The aim of this study was to compare the efficiency of ST and Ep maneuvers, to assess the value of liberatory signs in the recovery of symptoms and to evaluate the efficacy of postmaneuver restrictions by a daily VAS evaluation of vertigo and dizziness during the week following the maneuvers
Two-hundred and twenty-six consecutive adult patients suffering from a BPPV of the posterior semicircular canal on one side without any other cause of vertigo examined in one referral centre were included in this prospective study (Figure 1)

Summary

Introduction

To compare the efficiency of Epley (Ep) and Semont-Toupet (ST) repositioning maneuvers and to evaluate postmaneuver restriction effect on short-term vertigo and dizziness after repositioning maneuvers by an analog visual scale (VAS) in benign positional paroxysmal vertigo (BPPV). VAS scores decreased in patients with and without liberatory signs. We studied the validity of VAS in assessing vertigo and dizziness independently and on a daily basis after repositioning maneuvers in BBPV. Several European centers focused on this technique [8] Epley described his repositioning maneuver in 1992 [9], which is currently practiced by many centers worldwide [10, 11]. The comparison of these 2 maneuvers by a referral center is rarely reported (for review see [12])

Objectives

Methods

Conclusion