Successful management of benign paroxysmal positional vertigo with the epley manoeuvre

Role of Electronystagmography in Diagnosis of Secondary BPPV in Elderly Patients with Vertigo: A Retrospective Study

Elderly population is frequently affected by vertigo which affects their mobility and makes them vulnerable to fall and other morbidities. Often these patient visit neurologist and are often subjected to CT scan, MRI brain etc. to rule out a central cause of vertigo; whereas majority of these patients suffer from vestibular cause of vertigo. A schematic approach by detailed history, simple tests for vestibular functions like Dix Hallpike, supine roll and head impulse test give important clue to diagnosis. Often the diagnosis is benign paroxysmal positional vertigo (BPPV) which is treated by repositioning maneuver. There are often other vestibular causes which may be diagnosed by Electronystagmography (ENG), electrocochleography and other tests. This study was undertaken to study occurrence of secondary BPPV utilizing various parameters of ENG. The study group comprised of 131 patients from the neuro-otology proforma data base at ENT centre and vertigo clinic from January 2015 to December 2017. Inclusion criterion was male and female aged 51 years and above presenting with dizziness, imbalance, rotational vertigo, unsteadiness as the chief complaint. Exclusion criterion was BPPV relieved after Epley's maneuver, Otitis externa, acute Otitis media, Suppurative Otitis media, pre existing neurological condition and history of ear surgery. Neuro-otology Data obtained and the ENG findings were tabulated in the master chart and the observations interpreted and transferred to Claussen's butterfly chart. The study group comprised of 58 male (44.27%) and 73 female (55.73%) with a male female ratio of 1:1.25. ENG exhibited 36 patients (27.49) to have recurrent BPPV, 53 (40.45%) were found to have unilateral/bilateral canal paresis. Meniere's disease was diagnosed in 39 (29.77%) patients and brain stem pathology identified in 3 (2.29%) cases.

Effectiveness of the Parnes particle repositioning manoeuvre for posterior canal benign paroxysmal positional vertigo

BACKGROUND

Benign paroxysmal positional vertigo is a common vestibular disorder that negatively affects an individual's health-related quality of life. This study aimed to examine the effectiveness of the Parnes particle repositioning manoeuvre as an intervention for individuals with posterior canal benign paroxysmal positional vertigo.

METHODS

The de-identified records of 155 individuals treated with the Parnes manoeuvre were examined. Descriptive statistics were calculated, including the frequency and valid per cent of participants whose nystagmus was resolved with the Parnes manoeuvre.

RESULTS

In all, nystagmus was resolved with the Parnes manoeuvre in 145 participants (93.5 per cent). The mean number of manoeuvres needed to resolve the nystagmus was 1.3.

CONCLUSION

The Parnes manoeuvre proved to be as effective as the Epley canalith repositioning manoeuvre, currently the most common intervention, in treating individuals with posterior canal benign paroxysmal positional vertigo.

Rapid Systematic Review of Repeated Application of the Epley Maneuver for Treating Posterior BPPV

Objective

To evaluate the effect of repeated application of the Epley maneuver on patient-reported symptom relief and resolution of nystagmus in patients with posterior benign paroxysmal positional vertigo (p-BPPV).

Data Sources

PubMed, Embase, and the Cochrane Library.

Methods

A systematic search was conducted. Studies reporting original study data were included. Relevance and risk of bias (RoB) of the selected articles were assessed. Studies with low relevance, high RoB, or both were excluded. Success percentages and mean values were extracted.

Results

A total of 955 unique studies were retrieved. Fourteen of these satisfied the eligibility criteria. All of the included studies carried a high relevance and a moderate RoB. The majority of studies were 1-armed trials, in which the Epley was repeated only in case previous attempt(s) had failed. The maneuver was not repeated if it was successful. In 32% to 90% of patients, the first treatment session was successful. Reported cumulative success percentages ranged from 40% to 100% after the second session, 67% to 98% after the third session, 87% to 100% after the fourth session, and 100% in the studies in which patients received 5 sessions. One study evaluating the effect of multiple maneuvers in a single session showed a rise in success percentages from 84% for 1 maneuver to 90% after 2 maneuvers and 92% after 3 maneuvers.

Conclusion

Multiple studies with moderate RoB show a beneficial effect of multiple sessions of the Epley maneuver in p-BPPV patients who are not fully cleared of symptoms after the first session.

Epley's canalith-repositioning manoeuvre for benign paroxysmal positional vertigo

The efficacy of the Epley's canalith-repositioning manoeuvre in the treatment of BPPV was assessed in this prospective study of 62 patients. Patients were selected based on symptoms of positional vertigo and positive Dix-Hallpike's positional test. Patients were divided into two groups; first group comprising 34 patients underwent Epley's manoeuvre alone where as the other group comprising 28 patients underwent Epley's manoeuvre along with mastoid oscillator. At the end of 1 month patients were assessed subjectively by visual analogue scale (VAS) and objectively by Dix-Hallpike's positional test. On VAS, 85.7% patients had complete resolution of symptoms of BPPV in both the groups. Objectively 88.2% did not have positional nysfagmus after 1 month in first group whereas in the second group 86% had complete response at the end of 1 month of therapy. Follow up of 6 months could be done in 38 patients, out of which 7 (18.4%) had recurrence of their symptom of vertigo and positive Dix-Hallpike's positional test, whereas one patient continued to have no relief by Epley's manoeuvre. There was no difference in subjective and objective parameters even when CRP was performed using mastoid vibrator.