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Ballvé Moreno, José Luis - One of the best experts on this subject based on the ideXlab platform.
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Efectividad de la maniobra de Epley realizada en atención primaria para tratar el vértigo posicional paroxístico benigno del canal posterior /
2019Co-Authors: Ballvé Moreno, José Luis, Universitat Autònoma De Barcelona. Departament De MedicinaAbstract:Introducción El vértigo posicional paroxístico benigno del canal posterior es una patología prevalente en las consultas de atención primaria. Su abordaje diagnóstico consiste en una historia clínica y un examen físico, y su tratamiento es la maniobra de Epley. Existen escasas evidencias publicadas sobre la efectividad de la maniobra de Epley en atención primaria. Objetivos Analizar la eficacia de una sola maniobra de Epley en atención primaria. Diseño y ámbito Ensayo clínico aleatorizado, doble ciego con grupo control realizado en 2 CAP. Métodos Sujetos. Pacientes mayores de 18 años con diagnóstico de vértigo posicional paroxístico benigno del canal posterior subjetivo (vértigo solamente) y objetivo (vértigo y nistagmo) después de una prueba de Dix-Hallpike (PDH). Grupo de intervención: maniobra de Epley. Grupo de control: maniobra simulada. Se prescribió betahistina siguiendo el mismo régimen en ambos grupos para permitir la comparabilidad entre grupos. Principales medidas de resultado: Respuesta a la PDH, clasificada como negativa, positiva para vértigo o nistagmo (PDH positiva), positiva para el vértigo solamente (PDH positiva sin nistagmo) o para nistagmo y vértigo (PDH Positiva con nistagmo); resolución autorreportada del vértigo; y la severidad autoinformada del vértigo. Evaluaciones a 1 semana, 1 mes y 1 año. Resultados Se incluyeron 134 pacientes: 66 en el grupo de intervención y 68 en el grupo de maniobra simulada. El grupo de intervención mostró en los análisis no ajustados a la semana 1, una tasa de PDH positiva con nistagmo del 21,54% en el grupo control y del 6,67% en el grupo intervención (p=0,022). La severidad del vértigo en la primera semana fue de 5 en el grupo control y 3 en el grupo intervención (p=0,086). En los análisis multivariantes, en los pacientes con PDH positiva con nistagmo en la visita basal se observó una reducción de la severidad del vértigo (efecto marginal para la pregunta tipo Likert= -1,73 [-2,95, -0,51]) y mejores tasas de PDH Positiva en el grupo de intervención (odds ratio ajustado = 0,095 [0,010], 0,924]). Discusión Los resultados del estudio mostraron una disminución significativa de más de tres veces en la PDH positiva con nistagmo en la primera semana y una disminución de la severidad del vértigo de 2 puntos con cifras cercanas a la significación estadística en los análisis no ajustados, mientras que en los análisis multivariantes la efectividad de la ME vino condicionada por la presencia de nistagmo en la visita basal. En este subgrupo de pacientes se observó una disminución de la probabilidad de tener una PDH Positiva y una disminución de 2 puntos en la severidad percibida del vértigo como respuesta a la ME. Conclusiones En conclusión una sola maniobra de Epley realizada en atención primaria es un tratamiento efectivo para revertir una PDH Positiva y reducir la severidad del vértigo en pacientes con VPPB del canal posterior que tengan nistagmo en la PDH en la visita basal. 18 years diagnosed with subjective or objective posterior canal benign paroxysmal positional vertigo (vertigo only or vertigo and nystagmus) after a Dix-Hallpike Test (PDH). Intervention group: Epley manoeuvre. Control group: sham manoeuvre. Betahistine was prescribed following the same regimen in both groups to enable between-group comparisons. Main outcome measures: Response to the PDH, classified as negative, positive for vertigo only or for nystagmus and vertigo (Positive PDH), positive for both vertigo and nystagmus (Positive PDH with nistagmus), positive for vertigo only (Positive PDH without nistagmus) ; self-reported resolution of vertigo; and self-reported severity of vertigo evaluated on a 10-point Likert scale (10=worst imaginable vertigo). Evaluations at 1 week, 1 month and 1 year. Results The intervention group showed in the analysis not adjusted for week 1, a positive PDH with nistagmus rate of 21.54% in the control group and 6.67% in the intervention group (p=0.022). The severity of vertigo in the first week was 5 in the control group and 3 in the intervention group (p=0.086). The effectiveness of the Epley manoeuvre was influenced by the presence of baseline PDH with nistagmus in the multivariate analyses. In this subgroup of patients, there was a decrease in the probability of having a positive PDH and a decrease of 2 points in the perceived severity of vertigo as a response to ME. Discussion The results of the study showed a significant decrease of more than three times in the positive PDH with nistagmus in the first week and a decrease in the severity of the vertigo of 2 points with figures close to statistical significance in the unadjusted analyzes, while in the analyzes multivariate the effectiveness of ME was conditioned by the presence of PDH with nistagmus at the baseline visit. In the multivariate analyzes, in the patients with positive PDH with nystagmus at the baseline visit, a reduction in the severity of vertigo was observed (marginal effect for the Likert-type question = -1.73 [-2.95, -0, 51]) and better rates of positive PDH in the intervention group (adjusted odds ratio = 0.095 [0.010], 0.924]). Conclusions A single Epley manoeuvre performed in primary care is an effective treatment for reversing a Positive PDH and reducing vertigo severity in patients with nystagmus in the PDH at baseline
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Efectividad de la maniobra de Epley realizada en atención primaria para tratar el vértigo posicional paroxístico benigno del canal posterior
'Universitat Autonoma de Barcelona', 2018Co-Authors: Ballvé Moreno, José LuisAbstract:Introducción El vértigo posicional paroxístico benigno del canal posterior es una patología prevalente en las consultas de atención primaria. Su abordaje diagnóstico consiste en una historia clínica y un examen físico, y su tratamiento es la maniobra de Epley. Existen escasas evidencias publicadas sobre la efectividad de la maniobra de Epley en atención primaria. Objetivos Analizar la eficacia de una sola maniobra de Epley en atención primaria. Diseño y ámbito Ensayo clínico aleatorizado, doble ciego con grupo control realizado en 2 CAP. Métodos Sujetos. Pacientes mayores de 18 años con diagnóstico de vértigo posicional paroxístico benigno del canal posterior subjetivo (vértigo solamente) y objetivo (vértigo y nistagmo) después de una prueba de Dix-Hallpike (PDH). Grupo de intervención: maniobra de Epley. Grupo de control: maniobra simulada. Se prescribió betahistina siguiendo el mismo régimen en ambos grupos para permitir la comparabilidad entre grupos. Principales medidas de resultado: Respuesta a la PDH, clasificada como negativa, positiva para vértigo o nistagmo (PDH positiva), positiva para el vértigo solamente (PDH positiva sin nistagmo) o para nistagmo y vértigo (PDH Positiva con nistagmo); resolución autorreportada del vértigo; y la severidad autoinformada del vértigo. Evaluaciones a 1 semana, 1 mes y 1 año. Resultados Se incluyeron 134 pacientes: 66 en el grupo de intervención y 68 en el grupo de maniobra simulada. El grupo de intervención mostró en los análisis no ajustados a la semana 1, una tasa de PDH positiva con nistagmo del 21,54% en el grupo control y del 6,67% en el grupo intervención (p=0,022). La severidad del vértigo en la primera semana fue de 5 en el grupo control y 3 en el grupo intervención (p=0,086). En los análisis multivariantes, en los pacientes con PDH positiva con nistagmo en la visita basal se observó una reducción de la severidad del vértigo (efecto marginal para la pregunta tipo Likert= -1,73 [-2,95, -0,51]) y mejores tasas de PDH Positiva en el grupo de intervención (odds ratio ajustado = 0,095 [0,010], 0,924]). Discusión Los resultados del estudio mostraron una disminución significativa de más de tres veces en la PDH positiva con nistagmo en la primera semana y una disminución de la severidad del vértigo de 2 puntos con cifras cercanas a la significación estadística en los análisis no ajustados, mientras que en los análisis multivariantes la efectividad de la ME vino condicionada por la presencia de nistagmo en la visita basal. En este subgrupo de pacientes se observó una disminución de la probabilidad de tener una PDH Positiva y una disminución de 2 puntos en la severidad percibida del vértigo como respuesta a la ME. Conclusiones En conclusión una sola maniobra de Epley realizada en atención primaria es un tratamiento efectivo para revertir una PDH Positiva y reducir la severidad del vértigo en pacientes con VPPB del canal posterior que tengan nistagmo en la PDH en la visita basal.Background Posterior canal benign paroxysmal positional vertigo is a prevalent condition in primary care consultations. Its diagnostic approach consists of a medical history and physical examination, and its treatment is the Epley manoeuvre.There is scarce evidence on the effectiveness of the Epley manœuvre in Primary Care. Aim To study the effectiveness at 1 week, 1 month, and 1 year of a single Epley manoeuvre versus a sham manoeuvre in primary care. Design and Setting Multicentre, double-blind randomised controlled trial. Two primary care practices. Method Patients > 18 years diagnosed with subjective or objective posterior canal benign paroxysmal positional vertigo (vertigo only or vertigo and nystagmus) after a Dix-Hallpike Test (PDH). Intervention group: Epley manoeuvre. Control group: sham manoeuvre. Betahistine was prescribed following the same regimen in both groups to enable between-group comparisons. Main outcome measures: Response to the PDH, classified as negative, positive for vertigo only or for nystagmus and vertigo (Positive PDH), positive for both vertigo and nystagmus (Positive PDH with nistagmus), positive for vertigo only (Positive PDH without nistagmus) ; self-reported resolution of vertigo; and self-reported severity of vertigo evaluated on a 10-point Likert scale (10=worst imaginable vertigo). Evaluations at 1 week, 1 month and 1 year. Results The intervention group showed in the analysis not adjusted for week 1, a positive PDH with nistagmus rate of 21.54% in the control group and 6.67% in the intervention group (p=0.022). The severity of vertigo in the first week was 5 in the control group and 3 in the intervention group (p=0.086). The effectiveness of the Epley manoeuvre was influenced by the presence of baseline PDH with nistagmus in the multivariate analyses. In this subgroup of patients, there was a decrease in the probability of having a positive PDH and a decrease of 2 points in the perceived severity of vertigo as a response to ME. Discussion The results of the study showed a significant decrease of more than three times in the positive PDH with nistagmus in the first week and a decrease in the severity of the vertigo of 2 points with figures close to statistical significance in the unadjusted analyzes, while in the analyzes multivariate the effectiveness of ME was conditioned by the presence of PDH with nistagmus at the baseline visit. In the multivariate analyzes, in the patients with positive PDH with nystagmus at the baseline visit, a reduction in the severity of vertigo was observed (marginal effect for the Likert-type question = -1.73 [-2.95, -0, 51]) and better rates of positive PDH in the intervention group (adjusted odds ratio = 0.095 [0.010], 0.924]). Conclusions A single Epley manoeuvre performed in primary care is an effective treatment for reversing a Positive PDH and reducing vertigo severity in patients with nystagmus in the PDH at baseline
Malcolm P Hilton - One of the best experts on this subject based on the ideXlab platform.
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the epley canalith repositioning manoeuvre for benign paroxysmal positional vertigo
Cochrane Database of Systematic Reviews, 2014Co-Authors: Malcolm P Hilton, Darren K PinderAbstract:BACKGROUND: This is an update of a Cochrane Review first published in The Cochrane Library in Issue 1, 2002 and previously updated in 2004 and 2007.Benign paroxysmal positional vertigo (BPPV) is a syndrome characterised by short-lived episodes of vertigo in association with rapid changes in head position. It is a common cause of vertigo presenting to primary care and specialist otolaryngology clinics. Current treatment approaches include rehabilitative exercises and physical manoeuvres, including the Epley manoeuvre. OBJECTIVES: To assess the effectiveness of the Epley manoeuvre for posterior canal BPPV. SEARCH METHODS: We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; CENTRAL; PubMed; EMBASE; CINAHL; Web of Science; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 23 January 2014. SELECTION CRITERIA: Randomised controlled trials of the Epley manoeuvre versus placebo, no treatment or other active treatment for adults diagnosed with posterior canal BPPV (including a positive Dix-Hallpike Test). The primary outcome of interest was complete resolution of vertigo symptoms. Secondary outcomes were conversion of a 'positive' Dix-Hallpike Test to a 'negative' Dix-Hallpike Test and adverse effects of treatment. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS: We included 11 trials in the review with a total of 745 patients.Five studies compared the efficacy of the Epley manoeuvre against a sham manoeuvre, three against other particle repositioning manoeuvres (Semont, Brandt-Daroff and Gans) and three against a control (no treatment, medication only, postural restriction). Patients were treated in hospital otolaryngology departments in eight studies and family practices in two studies. All patients were adults aged 18 to 90 years old, with a sex ratio of 1:1.5 male to female.There was a low risk of overall bias in the studies included. All studies were randomised with six applying sealed envelope or external allocation techniques. Eight of the trials blinded the assessors to the participants' treatment group and data on all outcomes for all participants were reported in eight of the 11 studies. Complete resolution of vertigo Complete resolution of vertigo occurred significantly more often in the Epley treatment group when compared to a sham manoeuvre or control (odds ratio (OR) 4.42, 95% confidence interval (CI) 2.62 to 7.44; five studies, 273 participants); the proportion of patients resolving increased from 21% to 56%. None of the trials comparing Epley versus other particle repositioning manoeuvres reported vertigo resolution as an outcome. Conversion of Dix-Hallpike positional Test result from positive to negative Conversion from a positive to a negative Dix-Hallpike Test significantly favoured the Epley treatment group when compared to a sham manoeuvre or control (OR 9.62, 95% CI 6.0 to 15.42; eight studies, 507 participants). There was no difference when comparing the Epley with the Semont manoeuvre (two studies, 117 participants) or the Epley with the Gans manoeuvre (one study, 58 participants). In one study a single Epley treatment was more effective than a week of three times daily Brandt-Daroff exercises (OR 12.38, 95% CI 4.32 to 35.47; 81 participants). Adverse effects Adverse effects were infrequently reported. There were no serious adverse effects of treatment. Rates of nausea during the repositioning manoeuvre varied from 16.7% to 32%. Some patients were unable to tolerate the manoeuvres because of cervical spine problems. AUTHORS' CONCLUSIONS: There is evidence that the Epley manoeuvre is a safe, effective treatment for posterior canal BPPV, based on the results of 11, mostly small, randomised controlled trials with relatively short follow-up. There is a high recurrence rate of BPPV after treatment (36%). Outcomes for Epley manoeuvre treatment are comparable to treatment with Semont and Gans manoeuvres, but superior to Brandt-Daroff exercises.
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modifications of the epley canalith repositioning manoeuvre for posterior canal benign paroxysmal positional vertigo bppv
Cochrane Database of Systematic Reviews, 2012Co-Authors: William Hunt, Eleanor F Zimmermann, Malcolm P HiltonAbstract:Background Benign paroxsymal positional vertigo (BPPV) is a syndrome characterised by short-lived episodes of vertigo associated with rapid changes in head position. It is a common cause of vertigo presenting to primary care and specialist otolaryngology (ENT) clinics. BPPV of the posterior canal is a specific type of BPPV for which the Epley (canalith repositioning) manoeuvre is a verified treatment. A range of modifications of the Epley manoeuvre are used in clinical practice, including post-Epley vestibular exercises and post-Epley postural restrictions. Objectives To assess whether the various modifications of the Epley manoeuvre for posterior canal BPPV enhance its efficacy in clinical practice. Search methods We searched the Cochrane ENT Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the search was 15 December 2011. Selection criteria Randomised controlled trials of modifications of the Epley manoeuvre versus a standard Epley manoeuvre as a control in adults with posterior canal BPPV diagnosed with a positive Dix-Hallpike Test. Specific modifications sought were: application of vibration/oscillation to the mastoid region, vestibular rehabilitation exercises, additional steps in the Epley manoeuvre and post-treatment instructions relating to movement restriction. Data collection and analysis Two authors independently selected studies from the search results and the third author reviewed and resolved any disagreement. Two authors independently extracted data from the studies using standardised data forms. All authors independently assessed the trials for risk of bias. Main results The review includes 11 trials involving 855 participants. A total of nine studies used post-Epley postural restrictions as their modification of the Epley manoeuvre. There was no evidence of a difference in the results for post-treatment vertigo intensity or subjective assessment of improvement in individual or pooled data. All nine trials included the conversion of a positive to a negative Dix-Hallpike Test as an outcome measure. Pooled data identified a significant difference from the addition of postural restrictions in the frequency of Dix-Hallpike conversion when compared to the Epley manoeuvre alone. In the experimental group 88.7% (220 out of 248) patients versus 78.2% (219 out of 280) in the control group converted from a positive to negative Dix-Hallpike Test (risk ratio (RR) 1.13, 95% confidence interval (CI) 1.05 to 1.22, P = 0.002). No serious adverse effects were reported, however three studies reported minor complications such as neck stiffness, horizontal BPPV, dizziness and disequilibrium in some patients. There was no evidence of benefit of mastoid oscillation applied during the Epley manoeuvre, or of additional steps in the Epley manoeuvre. No adverse effects were reported. Authors' conclusions There is evidence supporting a statistically significant effect of post-Epley postural restrictions in comparison to the Epley manoeuvre alone. However, it important to note that this statistically significant effect only highlights a small improvement in treatment efficacy. An Epley manoeuvre alone is effective in just under 80% of patients with typical BPPV. The additional intervention of postural restrictions has a number needed to treat (NNT) of 10. The addition of postural restrictions does not expose the majority of patients to risk of harm, does not pose a major inconvenience, and can be routinely discussed and advised. Specific patients who experience discomfort due to wearing a cervical collar and inconvenience in sleeping upright may be treated with the Epley manoeuvre alone and still expect to be cured in most instances. There is insufficient evidence to support the routine application of mastoid oscillation during the Epley manoeuvre, or additional steps in an 'augmented' Epley manoeuvre. Neither treatment is associated with adverse outcomes. Further studies should employ a rigorous randomisation technique, blinded outcome assessment, a post-treatment Dix-Hallpike Test as an outcome measure and longer-term follow-up of patients.
Universitat Autònoma De Barcelona. Departament De Medicina - One of the best experts on this subject based on the ideXlab platform.
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Efectividad de la maniobra de Epley realizada en atención primaria para tratar el vértigo posicional paroxístico benigno del canal posterior /
2019Co-Authors: Ballvé Moreno, José Luis, Universitat Autònoma De Barcelona. Departament De MedicinaAbstract:Introducción El vértigo posicional paroxístico benigno del canal posterior es una patología prevalente en las consultas de atención primaria. Su abordaje diagnóstico consiste en una historia clínica y un examen físico, y su tratamiento es la maniobra de Epley. Existen escasas evidencias publicadas sobre la efectividad de la maniobra de Epley en atención primaria. Objetivos Analizar la eficacia de una sola maniobra de Epley en atención primaria. Diseño y ámbito Ensayo clínico aleatorizado, doble ciego con grupo control realizado en 2 CAP. Métodos Sujetos. Pacientes mayores de 18 años con diagnóstico de vértigo posicional paroxístico benigno del canal posterior subjetivo (vértigo solamente) y objetivo (vértigo y nistagmo) después de una prueba de Dix-Hallpike (PDH). Grupo de intervención: maniobra de Epley. Grupo de control: maniobra simulada. Se prescribió betahistina siguiendo el mismo régimen en ambos grupos para permitir la comparabilidad entre grupos. Principales medidas de resultado: Respuesta a la PDH, clasificada como negativa, positiva para vértigo o nistagmo (PDH positiva), positiva para el vértigo solamente (PDH positiva sin nistagmo) o para nistagmo y vértigo (PDH Positiva con nistagmo); resolución autorreportada del vértigo; y la severidad autoinformada del vértigo. Evaluaciones a 1 semana, 1 mes y 1 año. Resultados Se incluyeron 134 pacientes: 66 en el grupo de intervención y 68 en el grupo de maniobra simulada. El grupo de intervención mostró en los análisis no ajustados a la semana 1, una tasa de PDH positiva con nistagmo del 21,54% en el grupo control y del 6,67% en el grupo intervención (p=0,022). La severidad del vértigo en la primera semana fue de 5 en el grupo control y 3 en el grupo intervención (p=0,086). En los análisis multivariantes, en los pacientes con PDH positiva con nistagmo en la visita basal se observó una reducción de la severidad del vértigo (efecto marginal para la pregunta tipo Likert= -1,73 [-2,95, -0,51]) y mejores tasas de PDH Positiva en el grupo de intervención (odds ratio ajustado = 0,095 [0,010], 0,924]). Discusión Los resultados del estudio mostraron una disminución significativa de más de tres veces en la PDH positiva con nistagmo en la primera semana y una disminución de la severidad del vértigo de 2 puntos con cifras cercanas a la significación estadística en los análisis no ajustados, mientras que en los análisis multivariantes la efectividad de la ME vino condicionada por la presencia de nistagmo en la visita basal. En este subgrupo de pacientes se observó una disminución de la probabilidad de tener una PDH Positiva y una disminución de 2 puntos en la severidad percibida del vértigo como respuesta a la ME. Conclusiones En conclusión una sola maniobra de Epley realizada en atención primaria es un tratamiento efectivo para revertir una PDH Positiva y reducir la severidad del vértigo en pacientes con VPPB del canal posterior que tengan nistagmo en la PDH en la visita basal. 18 years diagnosed with subjective or objective posterior canal benign paroxysmal positional vertigo (vertigo only or vertigo and nystagmus) after a Dix-Hallpike Test (PDH). Intervention group: Epley manoeuvre. Control group: sham manoeuvre. Betahistine was prescribed following the same regimen in both groups to enable between-group comparisons. Main outcome measures: Response to the PDH, classified as negative, positive for vertigo only or for nystagmus and vertigo (Positive PDH), positive for both vertigo and nystagmus (Positive PDH with nistagmus), positive for vertigo only (Positive PDH without nistagmus) ; self-reported resolution of vertigo; and self-reported severity of vertigo evaluated on a 10-point Likert scale (10=worst imaginable vertigo). Evaluations at 1 week, 1 month and 1 year. Results The intervention group showed in the analysis not adjusted for week 1, a positive PDH with nistagmus rate of 21.54% in the control group and 6.67% in the intervention group (p=0.022). The severity of vertigo in the first week was 5 in the control group and 3 in the intervention group (p=0.086). The effectiveness of the Epley manoeuvre was influenced by the presence of baseline PDH with nistagmus in the multivariate analyses. In this subgroup of patients, there was a decrease in the probability of having a positive PDH and a decrease of 2 points in the perceived severity of vertigo as a response to ME. Discussion The results of the study showed a significant decrease of more than three times in the positive PDH with nistagmus in the first week and a decrease in the severity of the vertigo of 2 points with figures close to statistical significance in the unadjusted analyzes, while in the analyzes multivariate the effectiveness of ME was conditioned by the presence of PDH with nistagmus at the baseline visit. In the multivariate analyzes, in the patients with positive PDH with nystagmus at the baseline visit, a reduction in the severity of vertigo was observed (marginal effect for the Likert-type question = -1.73 [-2.95, -0, 51]) and better rates of positive PDH in the intervention group (adjusted odds ratio = 0.095 [0.010], 0.924]). Conclusions A single Epley manoeuvre performed in primary care is an effective treatment for reversing a Positive PDH and reducing vertigo severity in patients with nystagmus in the PDH at baseline
Darren K Pinder - One of the best experts on this subject based on the ideXlab platform.
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the epley canalith repositioning manoeuvre for benign paroxysmal positional vertigo
Cochrane Database of Systematic Reviews, 2014Co-Authors: Malcolm P Hilton, Darren K PinderAbstract:BACKGROUND: This is an update of a Cochrane Review first published in The Cochrane Library in Issue 1, 2002 and previously updated in 2004 and 2007.Benign paroxysmal positional vertigo (BPPV) is a syndrome characterised by short-lived episodes of vertigo in association with rapid changes in head position. It is a common cause of vertigo presenting to primary care and specialist otolaryngology clinics. Current treatment approaches include rehabilitative exercises and physical manoeuvres, including the Epley manoeuvre. OBJECTIVES: To assess the effectiveness of the Epley manoeuvre for posterior canal BPPV. SEARCH METHODS: We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; CENTRAL; PubMed; EMBASE; CINAHL; Web of Science; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 23 January 2014. SELECTION CRITERIA: Randomised controlled trials of the Epley manoeuvre versus placebo, no treatment or other active treatment for adults diagnosed with posterior canal BPPV (including a positive Dix-Hallpike Test). The primary outcome of interest was complete resolution of vertigo symptoms. Secondary outcomes were conversion of a 'positive' Dix-Hallpike Test to a 'negative' Dix-Hallpike Test and adverse effects of treatment. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS: We included 11 trials in the review with a total of 745 patients.Five studies compared the efficacy of the Epley manoeuvre against a sham manoeuvre, three against other particle repositioning manoeuvres (Semont, Brandt-Daroff and Gans) and three against a control (no treatment, medication only, postural restriction). Patients were treated in hospital otolaryngology departments in eight studies and family practices in two studies. All patients were adults aged 18 to 90 years old, with a sex ratio of 1:1.5 male to female.There was a low risk of overall bias in the studies included. All studies were randomised with six applying sealed envelope or external allocation techniques. Eight of the trials blinded the assessors to the participants' treatment group and data on all outcomes for all participants were reported in eight of the 11 studies. Complete resolution of vertigo Complete resolution of vertigo occurred significantly more often in the Epley treatment group when compared to a sham manoeuvre or control (odds ratio (OR) 4.42, 95% confidence interval (CI) 2.62 to 7.44; five studies, 273 participants); the proportion of patients resolving increased from 21% to 56%. None of the trials comparing Epley versus other particle repositioning manoeuvres reported vertigo resolution as an outcome. Conversion of Dix-Hallpike positional Test result from positive to negative Conversion from a positive to a negative Dix-Hallpike Test significantly favoured the Epley treatment group when compared to a sham manoeuvre or control (OR 9.62, 95% CI 6.0 to 15.42; eight studies, 507 participants). There was no difference when comparing the Epley with the Semont manoeuvre (two studies, 117 participants) or the Epley with the Gans manoeuvre (one study, 58 participants). In one study a single Epley treatment was more effective than a week of three times daily Brandt-Daroff exercises (OR 12.38, 95% CI 4.32 to 35.47; 81 participants). Adverse effects Adverse effects were infrequently reported. There were no serious adverse effects of treatment. Rates of nausea during the repositioning manoeuvre varied from 16.7% to 32%. Some patients were unable to tolerate the manoeuvres because of cervical spine problems. AUTHORS' CONCLUSIONS: There is evidence that the Epley manoeuvre is a safe, effective treatment for posterior canal BPPV, based on the results of 11, mostly small, randomised controlled trials with relatively short follow-up. There is a high recurrence rate of BPPV after treatment (36%). Outcomes for Epley manoeuvre treatment are comparable to treatment with Semont and Gans manoeuvres, but superior to Brandt-Daroff exercises.
Katherine D. Heidenreich - One of the best experts on this subject based on the ideXlab platform.
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Nystagmus Discordance with 2-Dimensional Videonystagmography in Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo
Otolaryngology–Head and Neck Surgery, 2015Co-Authors: Crystal M. Vanderheyden, Wendy J. Carender, Katherine D. HeidenreichAbstract:ObjectiveThe Dix-Hallpike Test is a standard component of the videonystagmography Test battery and can diagnose posterior semicircular canal benign paroxysmal positional vertigo. The purpose of this study is to determine the prevalence of discordant, equivocal, and concordant nystagmus tracings in active posterior semicircular canal benign paroxysmal positional vertigo when compared directly with the eye video.Study DesignCase series with chart review of patients diagnosed with posterior semicircular canal benign paroxysmal positional vertigo by 2-dimensional videonystagmography from August 1, 2007, to August 1, 2012.SettingA tertiary vestibular Test laboratory.Subjects and MethodsNinety-six adults (4 had bilateral involvement) with posterior semicircular canal benign paroxysmal positional vertigo were included. A total of 100 videos with accompanying videonystagmography tracings were reviewed to determine nystagmus trajectory as well as globe position. Descriptive statistics were used to describe prevale...