![]() 4Ĭaveats The measurement of the primary patient-oriented outcome was resolution of symptoms, particularly vertigo, however this and other symptoms were variably reported, and reported at different durations of follow-up. Nausea was the most commonly reported symptom, which could result in patients not tolerating the maneuver. However, there were no reported serious complications of the treatments. When compared to a control (no maneuver) or a sham maneuver (273 patients total), the Epley increased the likelihood of symptom resolution (odds ratio 4.4, 95% CI, 2.6 to 7.4 absolute risk difference : 35% Number-needed-to-treat : 3). Subjects were 18-90 years old, mostly female (74%), and all were diagnosed clinically. Of the five studies meeting these criteria and therefore included in the NNT calculation, all were prospective randomized control trials. Here we only report the analysis of the data where Epley maneuver was compared to control or a sham maneuver and where complete resolution of symptoms is reported as the primary outcome (some trials reported conversion of DHT from positive to negative as outcome). 4 Five trials compared the Epley maneuver against a sham maneuver, three against other canalith repositioning maneuvers, and three against a control (no treatment, medication only, or restricted positioning). The systematic review included 11 randomized trials with a total of 745 participants. The authors also examined adverse events associated with the maneuver. 4 The primary outcome was complete resolution for vertigo symptoms. ![]() The Cochrane review discussed here examined the effectiveness of the Epley maneuver for posterior canal BPPV. Other canalith repositioning maneuvers include the Semont, Brandt‐ Daroff and Gans. 3 It should be noted that the first movement of the Epley is the end position of the positive DHT. 2 The Epley maneuver was invented as a way to move the ear debris out of the semicircular canal, and involves a series of four sequential movements. ![]() 1 The condition is usually brought on by a rapid change in head position, and diagnosis can be confirmed by a positive Dix-Hallpike test (DHT). Narrative Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo, and is thought to be caused by free-floating debris primarily in the posterior semicircular canal.
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