No patients converted to horizontal canal benign paroxysmal positional vertigo. In the Epley maneuver group, 20 of 22 patients (91%) had long-term success (defined as a negative Dix-Hallpike result and a Dizziness Handicap Inventory score of 0) compared with 10 of 22 patients (46%) in the sham treatment group ( P =. Patients were retested at one, three, six, and 12 months, at which time they also completed the Dizziness Handicap Inventory. Patients were asked to sleep semi-upright and to avoid sleeping on the affected side for the next two nights. The Epley maneuver is a series of movements your doctor may use to treat your vertigo. The Dix-Hallpike test was repeated and the maneuver (sham or Epley) was repeated up to two more times if the test result was still positive. The patients were randomly assigned (concealed allocation unknown) to receive the Epley maneuver without premedication or a sham procedure of moving the head around. Trial Registration ClinicalTrials.These investigators enrolled 44 patients with posterior benign paroxysmal positional vertigo for at least one month confirmed by the Dix-Hallpike test. Nineteen patients (19.6%) in the EM group and 24 (24.5%) in the SM-plus group experienced relevant nausea.Ĭonclusions and Relevance The SM-plus self-maneuver is superior to the EM self-maneuver in terms of the number of days until recovery in pcBPPV. No serious adverse event was detected with both maneuvers. Your doctor turns your head to one side and then guides you back quickly until your shoulders are on the table and your head is hanging over the edge. For the secondary end point (effect of a single maneuver), no significant difference was detected (67 of 98 vs 61 of 97 P = .42 α = .05). The mean (SD) time until no positional vertigo attacks could be induced in the SM-plus group was 2.0 (1.6) days (median, 1 day 95% CI, 1.64-2.28 days) in the EM group, 3.3 (3.6) days (median, 2 days 95% CI, 2.62-4.06 days) ( P = .01 α = .05, 2-tailed Mann-Whitney test). When your head is firmly moved into different positions, the crystal debris (canaliths) causing vertigo will move freely and no longer cause symptoms. A single 10- to 15-minute session usually is all that is needed. Results Of the 195 participants included in the analysis, the mean (SD) age was 62.6 (13.9) years, and 125 (64.1%) were women. This manoeuvre is done with the assistance of a doctor or physiotherapist. The secondary end point was the effect of the single maneuver performed by the physician. The primary end point was the number of days until no positional vertigo could be induced on 3 consecutive mornings. Main Outcome and Measures Patients had to document whether they could provoke positional vertigo every morning. Interventions After being randomized to the SM-plus or the EM group, patients received 1 initial maneuver from a physician, then subsequently performed self-maneuvers at home 3 times in the morning, 3 times at noon, and 3 times in the evening. The analysis was prespecified and per-protocol. After consideration of the exclusion criteria as well as informed consent, 56 patients were excluded and 2 declined to participate, with 195 participants included in the final analysis. Two hundred fifty-three patients were assessed for eligibility. Patients were selected randomly during routine outpatient care after being referred to 1 of the 3 centers. Recruitment took place from June 1, 2020, until March 10, 2022. These videos are intended to demonstrate common vestibular exercises and/or canalith repositioning maneuvers to treat benign paroxysmal positional vertigo. Objective To compare the effectiveness of the Semont-plus maneuver (SM-plus) and the Epley maneuver (EM) for treatment of posterior canal benign paroxysmal positional vertigo (pcBPPV) canalolithiasis.ĭesign, Setting, and Participants This prospective randomized clinical trial was performed at 3 national referral centers (in Munich, Germany Siena, Italy and Bruges, Belgium) over 2 years, with a follow-up to 4 weeks after the initial examination. Importance Questions remain concerning treatment efficacy for the common condition of benign paroxysmal positional vertigo (BPPV).
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