Efficacy of Epley maneuver in treatment of benign paroxysmal positional vertigo of the posterior semicircular canal

Abstract

Background/Aim. Benign paroxysmal positional vertigo is one of the most frequent peripheral vestibular system disorders. The aim of this study was to examine the efficacy of the Epley maneuver in treating benign paroxysmal positional vertigo of the posterior semicircular canal (p- BPPV) and to discover possible causes of failure. Methods. This prospective study included 75 patients. In all the cases medical history showed and the positioning Dix-Hallpike test confirmed the diagnosis of p-BPPV. We also performed clinical ENT examination, searching for spontaneous nystagmus, vestibulospinal tests, caloric test, and audiometry. All the patients were treated by the modified Epley canalith repositioning maneuver. The patients were followed up at the intervals of seven and, fourteen days, and one, tree, and six months and one year. The maneuver was repeated if vertigo and nystagmus on control positioning test persisted. The transition from positive into negative Dix Hallpike test after one or two Epley maneuver was considered as success in treatment. Results. After the initial Epley maneuver the recovery rate was 90.7%, and after the second 96%. In three (4%) patients with secondary p-BPPV, symptoms did not cease even after the second repositioning maneuver. The etiology of p-BPPV had a significant effect on the maneuver?s success rate (p < 0.01), whereas duration of symptoms, age and gender had no effect (p > 0.05). After a successful treatment 11 (14.66%) patients had recurrent attack of BPPV during the first year. Conclusion. The Epley maneuver is very successful repositioning procedure in treating p- BPPV. The patients with idiopathic form p-BPPV showed higher success rate with Epley maneuver than those with secondary p-BPPV.Uvod/Cilj. Benigni paroksizmalni pozicioni vertigo (BPPV) predstavlja jedan od najcescih poremecaja perifernog cula za ravnotezu. Cilj istrazivanja bilo je da se proceni efikasnost manevra Epley u lecenju benignog paroksizmalnog pozicionog vertiga zadnjeg polukruznog kanala (p-BPPV) i utvrde potencijalni uzroci neuspeha ovog tretmana. Metode. U ovoj prospektivnoj studiji ispitano je 75 bolesnika. Kod svih bolesnika anamneza je ukazala na, a pozicionirajuci test po Dix-Hallpike-u potvrdio, dijagnozu p-BPPV. Svim bolesnicima je radjen i klinicki ORL pregled, traganje za spontanim nistagmusom, vestibulospinalni testovi, kalorijski test i tonalana liminarna audiometrija. Bolesnici su leceni modifikovanim repozicionim manevrom Epley, a kontrolni pregledi su zakazivani u intervalima od sedam i 14 dana, mesec, tri, sest meseci i godinu dana. Manevar je ponavljan, ako su vertigo i nistagmus na kontrolnom pozicionirajucem testu i dalje bili prisutni. Uspehom terapije smatran je prelazak ?pozitivnog? u ?negativan? Dix-Hallipike-ov test nakon jednog ili dva Epley-eva manevra. Rezultati. Nakon inicijalnog Epley-evog manevra izlecenje je zabelezeno kod 90,7% bolesnika, a nakon sekundarnog kod 96%. Tri (4%) bolesnika sa sekunadarnim p- BPPV-om ni nakon drugog repozicionog manevra nisu imala prestanak simptoma. Etioloski faktori p-BPPV-a imali su znacajan uticaj na stopu uspesnosti manevra (p < 0,01), dok duzina trajanja simptoma, starost i pol nisu (p > 0,05). Jedanaest (14,66%) bolesnika imalo je ponovljene epizode BPPVa u periodu od godinu dana nakon uspesnog Epley-evog manevra. Zakljucak. Manevar Epley pokazao se kao vrlo uspesna repoziciona metoda u lecenju p-BPPV. Bolesnici sa idiopatskim p-BPPV-om imali su bolje rezultate lecenja manevrom Epley nego bolesnici sa sekundarnim p-BPPV-om.