Epley Maneuver Research Articles

Benign Paroxysmal Positional Vertigo in Pregnancy

Background: Benign paroxysmal positional vertigo (BPPV) is a common clinical condition characterized by sudden, brief paroxysmal attacks of rotation vertigo occurred by changing the head position. BPPV is the most common peripheral vestibular pathology and is found frequently in females. There are very limited data on the association between BPPV and pregnancy. Objective: The objective of this study was to study the BPPV during pregnancy along with details of clinical manifestations and management. Patients and Methods: This is a cross-sectional study where pregnant women with BPPV were enrolled. The study was conducted between April 2020 and May 2022. Detailed neurological examinations were done at the vertigo clinic. Results: There were seven cases of BPPV associated with pregnancy in this study. The most common symptom was rotatory vertigo. All were diagnosed with the Dix–Hallpike test. All underwent Epley maneuver and symptoms resolved. Out of seven cases, two showed low 25-hydroxyvitamin D levels. Conclusion: Vertigo is a morbid symptom during pregnancy that affects both pregnant women and fetal status. To improve the quality of life during gestation, clinicians should consider this BPPV as an important clinical entity in their differential diagnosis of vertigo.

THE EFFECTS OF BETAHISTINE IN ADDITION TO EPLEY MANEUVRE IN THE POSTERIOR CANAL BPPV MANAGEMENT

Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder that accounts for one fth of all admissions to hospital due to vertigo although it is commonly undiagnosed.5 The most common form is idiopathic, and BPPV tends to occur at a higher rates in women than in men.6 The main mechanism underlying BPPV is accumulation of otoconia (calcium carbonate structures) in the lumen (canalolithiasis) or in the cupula (cupulolithiasis) of the semicircular canal, resulting in impaired uid dynamics of the semicircular canal. This randomized controlled trial and hospital based study was conducted at calcutta national medical college and hospital ENT OPD on July 2020 to June 2021. Total 75cases were taken in our study. Group A (Epley maneuver only) Group B (Epley maneuver only+ Tab Pentoprazol 40) Group C: Epley maneuver with betahistine (16mg TDS) Our study showed that in A Group, 10 patients had previous vertigo attack. In B Group, 13 patients had previous vertigo attack. In C Group, 11 patients had previous vertigo attack. Rest of the patient in our study presented with vertigo attack for 1st time in their life. Association of previous vertigo attack with group was not statistically signicant (p=0.290). In A Group, the mean visual vertigo analog scale Baseline (mean± s.d.) of patients was 6.98 ± 2.133. In B Group, the mean visual vertigo analog scale Baseline (mean± s.d.) of patients was 6.27 ± 2.148. In C Group, the mean visual vertigo analog scale Baseline (mean± s.d.) of patients was 6.21+/- 2.133. Difference of mean visual vertigo analog scale Baseline with Group was not statistically signicant (p=0.100). We concluded that group-C was better result in comparison with group-B and group-A respectively. So in our study it is found that patients treated with Epley's maneuver and Betahistine got better result than the patients treated with only Epley's maneuver.

Clinical and cVEMP Evaluation Predict Short-Term Residual Dizziness After Successful Repositioning in Benign Paroxysmal Positional Vertigo.

ObjectiveResidual dizziness (RD) is a frequent symptom with unknown pathogenesis, often complained about by the patients with benign paroxysmal positional vertigo (BPPV), even after a successful canalith repositioning procedure (CRP). This study aims to quantitatively evaluate the short-term RD severity and its risk factors in patients with BPPV after successful CRPs.MethodsIn total two hundred and twenty patients with BPPV after successful CRPs (W0) were prospectively followed up for 1 week (W1). Besides demographics and serial neuropsychological assessments (including dizziness handicap inventory-DHI, etc.), patients also received cervical/ocular vestibular evoked myogenic potential (c/oVEMP) evaluation. RD was defined as patients with dizziness or imbalance, dizziness visual analog scale (VAS) >1, and without positional vertigo or nystagmus at W1. Demographic, clinical, and VEMPs differences were compared among the three groups: patients with minor (dizziness VAS 1–3) and moderate-to-severe RD (dizziness VAS > 3) and without RD.ResultsThe total frequency of RD at W1 was 49.1% (n = 108), with 32.3% (n = 71) minor, and 16.8% (n = 37) moderate-to-severe RD. Logistic regression analyses revealed that RD was closely associated with DHI status (OR = 2.101, P = 0.008) at W0, this effect was not present for minor RD. In addition to DHI score > 30 (OR = 4.898, P < 0.001) at W0, bilateral cVEMP absence (OR = 4.099, P = 0.005) was also an independent influential factor of moderate-to-severe RD.ConclusionOur study highlights the importance of RD quantified evaluation. DHI score >30 and bilateral cVEMP absence could increase the risk of short-term moderate-to-severe RD.

Gans repositioning maneuver for the posterior canal BPPV patients: systematic review and meta-analysis.

BPPV (benign paroxysmal positional vertigo) is a syndrome marked by brief bouts of vertigo accompanied by rapid changes in head position. Recent ongoing therapeutic approaches used are vestibular rehabilitation exercises and physical maneuvers like the Epley maneuver, Semont maneuver. Gans repositioning maneuver (GRM) is a new hybrid maneuver, consisting of safe and comfortable series of postures that can be conveniently applied on patients with any spinal pathology or even in elderly. Randomized controlled/clinical trials of the Gans maneuver were identified. The proportion of patients who improved as a result of each intervention was assessed, as well as the conversion of a 'positive' Dix-Hallpike test to a 'negative' Dix-Hallpike test. Improvement was seen in almost all patients with the Gans maneuver and the Epley Maneuver in three trials with the pooled estimate for random effect model is 1.12 [0.87; 1.43: 100%]. There were no significant side effects from the treatment. This study shows that the Gans maneuver is a safe and effective treatment for patients suffering from posterior canal BPPV. The review is registered in Prospero with no. CRD42021234100.

A Comparative Study to Assess the Effectiveness of Epley’s Maneuver Vs Brandt Daroffs Home Exercises for Management of Benign Paroxysmal Positional Vertigo

Background:Vertigo is one of the most distressing symptom seen in patients encountered in clinical practice by otolaryngologist and neurologist. It results from dysfunction of vestibular system, among which most common is BBPV(benign paroxysmal positional vertigo). BPPV present with short episodes of vertigo lasting for few seconds, usually precipitated by change in head position. In BPPV, otoconia from utricles are thought to collect in semicircular canal making them abnormally gravity sensitive. BPPV is clinical diagnosis on the basis of typical history and Dix Hallpike testing. Dr. T Brandt and Daroff introduced Brandt daroff home exercises based on cupulolithiasis theory. In 1980, John M Epley introduced canalolith repositioning procedure of Epley in the treatment of BPPV. Because of lack of consensus regarding the optimal treatment maneuver, in our study we have compared the effectiveness of Brandt Daroff and Epleys maneuver.

Benign Paroxysmal Positional Vertigo in Children: A Narrative Review.

Benign paroxysmal positional vertigo is a rare vestibular disorder in the pediatric population. It is a vestibulopathy characterized by brief attacks of vertigo, which occur after specific movements. This review aims to provide the current evidence regarding benign paroxysmal positional vertigo in children. This is a narrative review of the available literature on benign paroxysmal positional vertigo in children. The studies were retrieved from systematic searches on PubMed and by cross referencing. Few studies have focused on pediatric benign paroxysmal positional vertigo, and most are retrospective non-controlled studies that include a small number of children. The vast majority of cases of benign paroxysmal positional vertigo in children have been reported to be secondary. The most frequent forms involve the posterior canal and the horizontal canal. The diagnosis is based on positional maneuvers, respectively the Dix–Hallpike maneuver, which reveals a torsional upbeating nystagmus; and the supine roll test, which reveals a geotropic, horizontal nystagmus. The treatment consists of physical repositioning maneuvers: the Semont or the modified Epley maneuver for benign paroxysmal positional vertigo involving the posterior canal and the Gufoni or the Barbecue maneuver in case of the horizontal canal. Benign paroxysmal positional vertigo in children can be resistant to treatment and repetitive positional maneuvers may be necessary, particularly for children with vestibular migraine or benign paroxysmal vertigo of childhood, who have a statistically significant major risk of having recurrences compared to patients who do not. Benign paroxysmal positional vertigo in children is a rare but well-recognized clinical entity. It is diagnosed by positional testing and treated by repositioning maneuvers. Wide awareness and education among pediatric providers and otolaryngologists are needed in order to avoid a delay in identification and treatment.

Balance Disorders: A Review of Patients at a Specialized Vestibular Clinic

Introduction: With recent advancements in vestibular assessments, new ancillary tests can assist clinicians to better understand underlying cause of a balance problem. The recently established specialized vestibular clinic in Sultan Ahmad Shah Medical Centre @IIUM is equipped with these tests. This study aimed to determine the prevalence of the different diagnoses of balance disorders in a specialized vestibular clinic in Kuantan, Malaysia. Materials and Methods: This is a retrospective review of 121 walk-in patients over an 18-month period at a specialized Vestibular Clinic in Sultan Ahmad Shah Medical Centre @IIUM. The variables analysed in this review include the age, gender, ethnicity, diagnoses, and total number of visits before diagnoses were achieved. Results: Meticulous history taking, focused otorhinolaryngological examination and detailed vestibular assessment through the specialized vestibular clinic helped us in reaching a conclusive diagnosis. The most common cause of balance disorders in our review was Benign Paroxysmal Positional Vertigo (BPPV), constituting 41.3% of the cases. Among the canals, the posterior canal is the most affected (70%) and is usually treated with Epley manoeuvre. Other common diagnoses include Vestibular Migraine, Meniere’s Disease and Vestibular Neuritis. Conclusion: Vestibular clinics play a vital role in helping to pinpoint the accurate diagnosis of patients with balance disorders.

Epley versus Semont Maneuver in the Treatment of Benign Paroxysmal Positional Vertigo

AbstractIntroduction Benign paroxysmal positional vertigo (BPPV) is characterized by brief but violent attacks of paroxysmal vertigo provoked by certain positions of the head. This study aimed to compare the outcomes of Epley and Semont maneuvers for the relief of vertigo in posterior semicircular canal BPPV.Materials and Methods This was a prospective comparative study conducted in a tertiary referral hospital over 1 year. Among 70 cases of BPPV, 35 were treated with Epley and 35 with Semont maneuver. Follow-up was done at 1 week, 1 month, and 3 months to assess symptomatic improvement using visual analogue scale.Results Out of 70 patients of BPPV, 62 patients responded very well to the maneuvers and got relief from vertigo. Thirty-two patients (91.4%) in the Epley group and 30 (85.7%) patients in the Semont group had a significant improvement post-therapy and the balance was the same in both groups. At 1 month, there was no significant statistical difference in mean visual analogue score (VAS) score between both groups.Conclusion Majority of cases showed symptomatic improvement with both maneuvers. However, patients treated with Epley maneuver showed earlier relief from vertigo than those treated with the Semont maneuver.

Risk factors for residual dizziness in patients with benign paroxysmal positional vertigo after successful repositioning: a systematic review and meta-analysis.

To investigate the risk factors for residual dizziness (RD) in patients with benign paroxysmal positional vertigo (BPPV) after successful repositioning. Searches were performed in PubMed, Embase, Cochrane library, Web of Science, Chinese National Knowledge Infrastructure, and Sino Med up to March 7, 2021 and references of relevant articles were screened. Data from eligible studies were meta-analyzed using Stata version 16.0 and Review Manager 5.4. In this systematic review and meta-analysis of 4487 patients from 31 studies, the prevalence of RD was 43.0% (95% CI 39.0-48.0%). Age (MD 4.17; 95% CI 2.13-6.21, P = 0.000), female gender (OR = 1.28, 95% CI 1.11-1.47, P = 0.001), secondary BPPV (OR 1.88; 95% CI 1.27-2.77, P = 0.001), a longer duration of BPPV before treatment (MD 3.45; 95% CI 1.87-5.02, P = 0.000), abnormal ocular vestibular evoked myogenic potential (OVEMP, OR 4.34; 95% CI 2.78-6.78, P = 0.000), abnormal cervical vestibular evoked myogenic potential (CVEMP, OR 2.48; 95% CI 1.54-3.99, P = 0.000), higher Dizziness Handicap Index (DHI) score before treatment (MD 10.88; 95% CI 5.96-15.80, P = 0.000), anxiety (OR 9.58; 95% CI 6.32-14.52, P = 0.000), osteopenia (OR = 4.40, 95% CI 2.17-8.96, P = 0.000), onset in winter (OR 7.27; 95% CI 2.38-22.24, P = 0.001) and with a history of BPPV (OR 1.79; 95% CI 1.06-3.04, P = 0.03) are the risk factors for RD in patients with BPPV after successful repositioning. The affected side, location or type of semicircular involvement, hyperlipidemia, diabetes, hypertension, heart disease, migraine, sleep disorders, canalolithiasis/cupulolithiasis, the number of times the canalith repositioning procedures (CRPs) were performed and number of vertigo attacks did not correlate with the occurrence of RD. Despite successful treatment, nearly half of the BPPV patients developed RD. RD seems to be a syndrome caused by multiple factors. The pathogenesis of most factors can be explained by psychological and/or physical disorders. Early recognition of these risk factors contributes to the prevention and treatment of RD.

Benign Paroxysmal Positional Vertigo (BPPV)

BPPV is a condition of disturbance of the peripheral vestibular system, when the patient feels the sensation of spinning and moving associated with nystagmus when the head position changes against gravity and is accompanied by symptoms of nausea, vomiting and cold sweats. The writing of this article includes various sources originating from scientific journals and government guidelines and related agencies. Source searches were carried out on online portals for journal publications such as MedScape Google Scholar (scholar.google.com) and the National Centre for Biotechnology Information/NCBI (ncbi.nlm.nih.gov), with the keyword ‘Benign paroxysmal positional vertigo (BPPV)”. BPPV is characterized by sudden, brief episodes of vertigo triggered by certain head movements that usually result from displacement of calcium-carbonate crystals or otoconia within the fluid-filled semicircular canals of the inner ear. The diagnosis of BPPV can be made based on anamnesis and physical examination which includes several tests, including the Dix-Hallpike. The diagnosis of BPPV can be made through clinical history along with diagnostic procedures. The management that is often used is non-pharmacological which includes several maneuvers such as the Epley maneuver, the Semount maneuver and the Lempert maneuver

Dizziness: Approach to Evaluation, Assessment and Management

Dizziness is a common symptom. It was traditionally divided into four categories based on the patient’s history: vertigo, presyncope, disequilibrium, and light-headedness. However, the distinction between these symptoms is of limited clinical usefulness. Patients have difficulty describing the quality of their symptoms but can more consistently identify the timing and triggers. Episodic vertigo triggered by head motion may be due to benign paroxysmal positional vertigo. Vertigo with unilateral hearing loss +/- tinnitus suggests Meniere disease. Episodic vertigo not associated with any trigger may be a symptom of vestibular neuritis. Evaluation focuses on determining whether the etiology is peripheral or central. Peripheral etiologies are usually benign. Central etiologies often require urgent treatment. The HINTS (head-impulse, nystagmus, test of skew) examination can help distinguish peripheral from central etiologies. The physical examination includes orthostatic blood pressure measurement, a full cardiac and neurologic examination, assessment for nystagmus, and the Dix-Hallpike maneuver. Laboratory testing and imaging are not required and are usually not helpful. Benign paroxysmal positional vertigo can be treated with a canalith repositioning procedure (Epley maneuver). Treatment of Meniere disease includes salt restriction and diuretics. Symptoms of vestibular neuritis are relieved with vestibular suppressant medications and vestibular rehabilitation.

An Effective Home-Based Particle Repositioning Procedure for Posterior Canal Benign Paroxysmal Positional Vertigo (BPPV).

Patients with benign paroxysmal positional vertigo (BPPV) find it difficult to visit the hospital many times for a standard Epley's maneuver performed only by a specialist. The aim of this study wasto compare the efficacy of a home-based particle repositioning procedure (HBPRP) with the standard Epley's maneuver in treating patients with posterior canal BPPV. A prospective non-blinded randomized controlled studywas conducted. Patients were randomized into two groups, where one group received the standard treatment and other received a new HBPRP. The vertigo scale, duration of nystagmus during Dix-Hallpike test and frequency of vertigo, were documented on first, second and third visits, with complications noted during the second and third visits. These parameters were compared between both the groups following the treatment, during all visits. The patients were randomized into 2 arms with 15 each. Those belonging to group 1 received Epley's maneuver and group 2 received HBPRP. There was no significant difference in the baseline characteristics of patients in both groups. Both groups of patients had significant improvement of symptoms at the end of the study. A comparison of both groups at 2nd and 3rd visits showed no differences in frequency of vertigo, reduction in vertigo scale and duration of nystagmus following Dix-Hallpike test between both groups. HBPRP is a safe and effective procedure and can be taught as a home-based treatment for patients diagnosed with posterior canal BPPV.

Current Therapies in Patients With Posterior Semicircular Canal BPPV, a Systematic Review and Network Meta-analysis.

To compare the efficacy of different treatments for posterior semicircular canal benign paroxysmal positional vertigo (PC-BPPV) by using direct and indirect evidence from existing randomized data. Randomized case-control studies that compared the efficacy of various nonsurgical treatments in PC-BPPV patients at 1 week and 1 month of follow-up were comprehensively screened. Bayesian network meta-analysis was performed to evaluate direct and indirect treatment comparisons. We further conducted subgroup pairwise meta-analysis to explore the inconsistency between comparisons of the Epley versus a sham maneuver and the Epley versus the Semont maneuver. A total of 41 parallel, randomized controlled studies were included. The Epley with vestibular rehabilitation (EVR), Epley, Semont and Hybrid maneuvers were effective in eliminating nystagmus during a Dix-Hallpike test at 1 week of follow-up (odds ratios [ORs]: 11.41-23.8, 95% credible interval [CrI]: excluding null), among which EVR showed the best efficacy (the surface area under the cumulative ranking curves [SUCRA] = 77.5%). However, at 1 month of follow-up, only the Semont (rank first, SUCRA = 76.1%) and Epley maneuvers (rank second, SUCRA = 65.3%) were effective in eliminating nystagmus during a Dix-Hallpike test. In the pairwise subgroup meta-analysis, for patients younger than 55 years of age, the efficacy of the Epley maneuver was comparable to that of the Semont maneuver [rate ratio (RR): 0.99, 95% confidence interval (CI): 0.93-1.05]; for patients with a longer duration before treatment, the effect of the Epley maneuver was equivalent to that of a sham maneuver (RR: 1.07, 95% CI: 0.90-1.29). Among the 12 types of PC-BPPV treatments, the Epley, Semont, EVR, and Hybrid maneuvers were effective in eliminating nystagmus during a Dix-Hallpike test for PC-BPPV at 1 week of follow-up, whereas only the Epley and Semont maneuvers were effective at 1 month of follow-up. The duration before treatments and the age of patients might contribute to the efficacy of treatments.

Comparison of the Effectiveness of TRV Chair and Canalith Repositioning Procedure (CRP) for the Treatment of Benign Paroxysmal Positional Vertigo (BPPV)

Comparison of the Effectiveness of TRV Chair and Canalith Repositioning Procedure (CRP) for the Treatment of Benign Paroxysmal Positional Vertigo (BPPV)

COMPARISON OF EFFICACY OF EPLEY MANOEUVRE AND VESTIBULAR SEDDATIVE IN POSITIONAL VERTIGO

Objective: To carry out the comparison of the effectiveness of Epleys manoeuvre and Vestibular Sedative in the management of benign paroxysmal positional vertigo.&#x0D; Study Design: Quasi experimental study.&#x0D; Place and Duration of Study: Department of ENT, Combined Military Hospital Peshawar, from Jul 2019 to Dec 2020.&#x0D; Methodology: The study was conducted on 60 patients who were diagnosed Benign Paroxysmal Positional Vertigo by Dix Hallpike test. The patients were divided into 2 groups of 30 each. Group A was treated with vestibular sedative and group B was treated with Epleys manoeuvre. The examination of all patients was done on day 3, day 7 and day 14 and the results were documented.&#x0D; Results: The study revealed that the 30 cases which were managed by Epleys manoeuvre, 27 cases were completely symptom free after 14 days. Meanwhile from the 30 patients who were treated by oral vestibular sedation, only 5 patients had total recovery on 14th day. Chi square test was used to compare the results. The results showed that Epleys manoeuvre has greater efficacy in the treatment of Epleys man oeuvre than vestibular sedative.&#x0D; Conclusion: Epleys manoeuvre is more effective for the management of benign paroxysmal positional vertigo than vestibular sedative.

Sudden Onset of Vestibular Migraine Complicated with BPPV and Mal de Debarquement Syndrome – a Diagnostic Dilemma

Vestibular migraine is combination of migraine and vestibular symptoms. In clinical examination it can be replaced with benign paroxysmal positional vertigo (BPPV) cupulolithiasis, but also BPPV is common comorbidity in migraine patients. There is also high association between vestibular migraine and Mal de Debarquement syndrome. Patient came to hospital with vertigo that was diagnosed as left PC-BPPV canalolithiasis. After first Epley's maneuver symptoms didn't resolved. Week after, at second Epley's maneuver performed patient developed left PC-BPPV cupulolithiasis. Month after, at third Epley's maneuver BPPV resolved but patient developed Mal de Debarquement syndrome. Laboratory testing showed hyperhomocisteinemia and homozygous MTHFR C677T and PAI, with low vitamin D. After reviewing the vestibular symptoms in the first attack which was misdiagnosed as BPPV canalolithiasis, and history of migraine, patient was diagnosed with vestibular migraine. Patient well responded to migraine diet and supplementation with B complex. Vestibular disorders are similar to each other and they can overlap. More attention in taking detailed medical history should be given to patients with vertigo or dizziness.

The efficacy of Epley and Semont maneuvers in posterior semicircular canal benign paroxysmal positional vertigo treatment: A short-term comparative study

OBJECTIVE: This study aimed to compare the effectiveness of the Epley maneuver with the Semont maneuver in the treatment of posterior semicircular canal benign paroxysmal positional vertigo and observe differences in the resolution time of symptoms in the short-term follow-up. METHODS: Sixty patients with posterior semicircular canal benign paroxysmal positional vertigo (23 males, 37 females; median age: 44.9 years; range, 14 to 80 years) were included in the prospective randomized comparative study conducted in our clinic between April 2019 and October 2019. Diagnosis and treatment maneuvers were performed under videonystagmography examination. Participants were randomly selected after the diagnostic tests for the Epley maneuver and the Semont maneuver treatment groups. RESULTS: In the evaluation of vertigo with videonystagmography, 25 (83.3%) patients in the Epley maneuver group and 20 (66.6%) patients in the Semont maneuver group recovered in the one-week follow-up, and 28 (93.3%) patients in the Epley maneuver group and 24 (80%) patients in the Semont maneuver group recovered in the two-week follow-up. All patients in the Epley maneuver group recovered at the end of one month; four patients in the Semont maneuver group still had vertiginous symptoms (100% vs. 86.6%, p=0.04). There was a statistically significant difference between the Epley and Semont groups regarding visual analog scores at the one-week, two-week, and one-month follow-ups (p=0.002, p&lt;0.001, p=0.001, respectively). CONCLUSION: The Epley maneuver was significantly more effective than the Semont maneuver in resolving vertigo in the short-term treatment of posterior semicircular canal benign paroxysmal positional vertigo.

Effect of the course of posterior semicircular canal benign paroxysmal positional vertigo on residual symptoms after successful canalith repositioning procedure

Objective:To investigate the effect of the course of posterior semicircular canal benign paroxysmal positional vertigo（BPPV） on residual symptoms after successful canalith repositioning procedure（CRP）. Methods:A total of 56 patients with posterior semicircular canal BPPV were selected from July 2020 to March 2021. They were divided into the short course group and the long course group according to the duration of disease from symptom onset to CRP treatment. All patients were treated with mechanical Epley repositioning procedure with rotary chair assistance. After successful repositioning treatment, they were followed up for seven to ten days. All patients were assessed using the vertigo disorder scale （DHI） before and after treatment,the differences of each dimension score and total score of DHI before and after successful CRP were compared between these two groups. Results:① After successful CRP, in patients with mild residual symptoms, the ratio between short course group and long course group were 68.6% and 31.4%, respectively. While in patients with moderate to severe residual symptoms,the ratio between short course group and long course group was 20% and 80%, respectively. The difference was statistically significant（P<0.05）. ②Before CRP, there was no significant difference in Physical dimension（DHI-P, 7 items） and in Function dimension（DHI-F, 9 items） between the two groups（P>0.05）, but there was significant difference in Emotion dimension（DHI-E, 9 items） and in total DHI score between the two groups（P<0.05, respectively）. After treatment, there was no significant difference in DHI-P score between the two groups（P>0.05）, but there were significant differences in DHI-F, DHI-E and DHI total score between the two groups（P<0.05,respectively）. Compared with the scores of DHI-P, DHI-F, DHI-E and DHI total score before and after successful CRP, the significant differences were found between the short course group and long course group（P<0.05,respectively）. ③There was no significant difference in the difference of DHI dimensions and total score between the short course group and the long course group before after reduction（P>0.05,respectively）. Conclusion:The duration of posterior semicircular canal BPPV（P-BPPV） does not affect the short-term efficacy of P-BPPV repositioning treatment, but patients with long course of P-BPPV are more likely to have moderate to severe residual symptoms after successful CRP，mainly in social function and emotional psychology.

Effect of age on treatment outcomes in benign paroxysmal positional vertigo: A systematic review.

Benign paroxysmal positional vertigo (BPPV) can lead to an increased fall risk in older adults. Therefore, we examined the influence of age on the effectiveness of canalith-repositioning procedures (CRPs) for the treatment of BPPV. Pubmed, Web of Science, and the bibliographies of selected articles were searched for studies conducted before September 2020 that examined the effectiveness of treatments for BPPV in various age groups. Meta-analyses were performed to compare treatment effectiveness and recurrence rates for younger and older adults. Odds ratios were calculated in a random-effects model. Mean differences were calculated using a fixed-effects model. A significance level of p < 0.05 (95% confidence interval) was set. The risk of bias and the methodological quality of all included articles were examined. Forty-five studies were retrieved after full-text screening, of which 29 studies were included for a qualitative review. The remaining 16 studies were eligible for inclusion in the meta-analysis (3267 participants with BPPV). The success rate of a single CRP was higher in the younger group (72.5% vs. 67%, p < 0.001). An average of 1.4 and 1.5 CRPs was needed for complete recovery in the younger and older groups, respectively (p=0.02). However, global treatment success did not differ between these groups (97.5% vs. 94.6%, p=0.41). The recurrence rate was higher in the older population (23.2% vs. 18.6%, p=0.007). Although more CRPs are needed, the rate of complete recovery in older adults is similar to that observed in younger adults.

The Efficacy of the Half Somersault Maneuver in Comparison to the Epley Maneuver in Patients with Benign Paroxysmal Positional Vertigo.

OBJECTIVE: Benign Paroxysmal Positional Vertigo (BPPV) as the most common vestibular disorder can affect the quality of life. This study aimed to compare the effectiveness of the half somersault maneuver (HSM) as a treatment to that of the Epley maneuver (EM) as a clinical-based treatment in subjects with PC-BPPV.Methods: In this randomized study, 43 participants with unilateral posterior canal BPPV were recruited. The experimental group received the HSM, whereas the control group received the EM. All participants were asked to fill in the Vestibular Rehabilitation Benefit Questionnaire (VRBQ), Dizziness Handicap Inventory (DHI), and Vertigo Symptom Scale (VSS) questionnaires at pretreatment and at 48 hours, 1 week, and 1 month post-treatment. The severity of residual dizziness was determined by the visual analog scale (VAS) weekly for up to 4 weeks after treatment. The success rate and the recurrence rate were assessed after the 3-month follow-up.Results: The differences between the results of pretreatment and post-treatment questionnaires for both groups were significant. However, the differences were not significant between the 2 groups for the DHI scores, the total, dizziness, motion-provoked dizziness, and symptom subscale scores of the VRBQ, and the anxiety subscale scores of the VSS. There were significant differences between the 2 groups for VAS, the total VSS and vertigo subscale scores, and the VRBQ anxiety subscale scores.Conclusion: Even though both maneuvers are significantly effective in the treatment of PC-BPPV, subjects in the HSM group reported more improvement in terms of psychometric symptoms and residual dizziness compared to the EM group.