Abstract
Objective: To investigate the therapeutic efficacies of the Epley maneuver and Brandt-Daroff (BD) exercise in patients with benign paroxysmal positional vertigo involving the posterior semicircular canal cupulolithiasis (PC-BPPV-cu).Methods: We conducted a randomized clinical trial to evaluate the therapeutic effect of the Epley maneuver and BD exercise in patients with PC-BPPV-cu. Patients were randomly assigned to undergo the Epley maneuver (n = 29) or BD exercise (n = 33). The primary outcome was an immediate resolution of positional nystagmus within 1 h after a single treatment of each maneuver on the visit day. Secondary outcomes included the resolution of positional nystagmus at 1 week, the change of maximal slow phase velocity (mSPV) of positional nystagmus, and dizziness handicap inventory (DHI) immediately and at 1 week.Results: Immediate resolution occurred in none of 29 patients in the Epley maneuver group and only 1 of 33 patients in the BD exercise group. The Epley maneuver and BD exercise had an equivalent effect at 1 week in treating PC-BPPV-cu in terms of resolving positional nystagmus (48 vs. 36%, p = 0.436) and the decrease of mSPV and DHI.Conclusion: Neither the Epley maneuver nor BD exercise has an immediate therapeutic effect in treating PC-BPPV-cu. Clear classification of PC-BPPV should be required at the time of different pathology and different treatment response.
Highlights
Cupulolithiasis of benign paroxysmal positional vertigo involving the posterior semicircular canal (PC-BPPV-cu) is a rare form of BPPV
This study conducted a randomized clinical trial to determine the treatment efficacies of the Epley maneuver and Brandt and Daroff (BD) exercise in patients with PC-BPPV-cu
Immediate resolution occurred in none of the 29 patients (0%) in the Epley maneuver group and in only 1 of 33 patients (3%) in the BD exercise group (Figure 2A)
Summary
Cupulolithiasis of benign paroxysmal positional vertigo involving the posterior semicircular canal (PC-BPPV-cu) is a rare form of BPPV. Epley previously described nystagmus characteristics and his clinical experience of diagnostic posture [1]. He suggested that half Hallpike maneuver can provoke persistent up and ipsitorsional nystagmus because the cupula of PC may be oriented along earth-horizontal axis, and the weighted cupula has maximal propensity to be deflected earthward [1]. Based on his theory, Barany’s society formulated the diagnostic criteria of PC-BPPV-cu on 2015 [2]. PC-BPPVcu generates upward and ipsitorsional nystagmus, but the duration of symptoms and positional nystagmus are longer (over 1 min) than experienced with canalolithiasis of PC-BPPV (PC-BPPV-ca) [1,2,3,4]
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