Efficacy of Epley’s canalith repositioning procedure according to the number of repetitions in the same session: comparison of three protocols

Abstract

Background

The canalith repositioning manoeuvre (CRM) described by Epley remains a grade A recommended treatment for Benign Paroxysmal Positional Vertigo (BPPV) of the posterior semicircular canal (PSC). However, significant variability in the efficacy of Epley CRM has been reported.

Aims

To compare the treatment efficacy of different combinations of the Epley CRM and Dix-Hallpike retest.

Material and methods

Patients with PSC BPPV were divided into one of the following three treatment groups. Manoeuvre group (M): patients underwent a single Epley CRM without subsequent Dix-Hallpike retesting. Manoeuvre-Control group (MC): patients underwent up to three Epley CRM followed by Dix-Hallpike retesting until nystagmus resolution. Manoeuvre-Control-Manoeuvre group (MCM): A similar procedure to that used in the MC group except that, after the negative Dix-Hallpike retest, there was an additional CRM.

Results

A more favourable tendency for recovery was observed in the MCM group. There was a positive odds ratio of 1.1 between groups M and MC at the first control, 2.7 between groups M and MCM, and 2.5 between groups MC and MCM.

Conclusions and significance

Close repetition of a single Epley CRM after the first effective one would allow a positional retest to be combined with a reduction in the risk of persistent/recurrent BPPV.

Chinese abstract

背景：Epley所描述的耳道小石再定位术（CRM）仍然是后半圆形耳道（PSC）的良性阵发性位置性眩晕（BPPV）的A级治疗方法。但是, 已有Epley CRM的有效性存在很大差异的报道。

目的：比较Epley CRM和DixHallpike再测试的不同组合的治疗效果。

材料和方法：PSC BPPV患者分为以下三个治疗组。操纵组（M）：患者接受单次Epley CRM, 无需随后的DixHallpike再测试。操纵-对照组（MC）：患者接受了最多3次Epley CRM, 然后接受Dix-Hallpike再测试直至眼球震颤消退。操纵-控制-操纵组（MCM）：这是与MC组相似的方法, 但在Dix-Hallpike再测试呈阴性后, 再进行一次CRM。

结果：在MCM组中观察到更有利的恢复趋势。在第一次对照治疗中, M组和MC组之间的正比值比为1.1；M组和MCM组之间的正比值比为2.7；在MC和MCM组之间为2.5。

结论和意义：在第一次有效的Epley CRM之后, 紧接着重复一次Epley CRM可以将位置重新测试与降低持久性/复发性BPPV的风险相结合。

Keywords:

• BPPV
• Epley manoeuvre
• repetition
• efficacy
• benign paroxysmal positional vertigo
• treatment

Disclosure statement

No potential conflict of interest was reported by the author(s).