Short-term efficacy of Epley’s manoeuvre: a double-blind randomised trial. (2006)

Abstract
BACKGROUND:
Benign paroxysmal positional vertigo of the posterior canal (PC-BPPV) is a common vestibular disorder and can be easily treated with Epley’s manoeuvre. Thus far, the short-term efficacy of Epley’s manoeuvre for treatment of PC-BPPV is unknown.

OBJECTIVES:
To evaluate the efficacy of Epley’s manoeuvre for treatment of PC-BPPV 24 h after applying the manoeuvre.

METHODS:
The short-term efficacy of Epley’s manoeuvre was compared with a sham procedure in 66 patients with PC-BPPV by using a double-blind randomised study design.

RESULTS:
24 h after treatment, 28 of 35 (80%) patients in the Epley’s manoeuvre group had neither vertigo nor nystagmus on positional testing compared with 3 of 31 (10%) patients in the sham group (p<0.001).

CONCLUSION:
Epley’s manoeuvre is shown to resolve PC-BPPV both effectively and rapidly.

My Comments:

This is not exactly breaking news or controversial anymore but I have been getting increasing referrals vestibular rehabilitation and often times it works but sometimes it doesn’t. I figured I could help my patients better if I looked into some of the newer maneuvers for treating BPPV (the most common cause of vertigo) and to compare new to old it would be worth looking at some of the earlier studies. This one seemed particularly well done, being a double blind controlled trial, with the sham treatment being the identical but opposite maneuver (for the wrong ear). Thus I expect the blinding was maintained pretty well and placebo effect well controlled for.  As the abstract says 80% were cured when tested 24 hours later with the Epley Maneuver as compared to 10% in the control group.

What was interesting to me, and not described in the abstract, was that the Epley maneuver was successful at eliminating symptoms 43% of the time with the first attempt, thus 57% required a 2nd or 3rd attempt to eliminate symptoms when retested with the Dix-Hallpike test. Somehow I missed that when reading Herdman, so if it didn’t work the first time I was on to my roll over maneuver. So going forward I’ll give Epley’s maneuver a couple extra tries. You learn something new every day.

Even in the newer papers the Epley maneuver is holding up really well as THE (or at least A) treatment of choice for BPPV with involvement of the posterior semicircular canal. The posterior canal is implicated by noting mixed torsional or upbeating nystagmus with the torsional component to the undermost/affected ear. Unfortunately BPPV descriptions aren’t exactly laymen friendly, nor necessarily physical therapist friendly, with diagnosis and treatment complicated when different, or more than one semicircular canal is affected. The great thing about BPPV is when hit it with the right canal with the right maneuver you are often an immediate hero. So I’m looking up my hero average a bit. I also learned “maneuver” is the American spelling, while the rest of the english speaking world uses “manoeuvre” but they mean and are pronounced the same. That’s two things for today.