林裕次郎, 國弘幸伸, 東野一隆, 齋藤晶, 神崎仁: 方向交代性頭位眼振の臨床的検討. Equilibrium Res 2000:59:198-205.
北島尚治, 鈴木衞, 堀口利之, 市村彰英, 小川恭生, 清水重敬, 竹之内剛: 頭位変換療法後のBPPVの経過について. Equilibrium Res 2004:63:28-33.
Bradford Alan Woodworth, M Boyd Gillespie, Paul R Lambert
The canalith repositioning procedure for benign positional vertigo: a meta-analysis.
Laryngoscope. 2004 Jul;114(7):1143-6. doi: 10.1097/00005537-200407000-00002.
Abstract/Text
OBJECTIVE: To review the effectiveness of the canalith repositioning procedure (CRP) in the treatment of benign paroxysmal positional vertigo (BPPV) with a critical review of the literature and meta-analysis.
STUDY DESIGN: Meta-analysis.
METHODS: Studies eligible for inclusion were randomized, controlled trials of the CRP performed on clearly defined cases of BPPV. A total of nine studies meeting inclusion criteria were identified by two independent literature searches of Medline. Treatment and control groups were compared for symptom resolution and elimination of a positive Dix-Hallpike test.
RESULTS: Patients treated with CRP were more likely to demonstrate symptom resolution (odds ratio [OR] 4.6; 95% confidence interval [CI] 2.8-7.6) and negative Dix-Hallpike (OR 5.2; 95% CI 3.0-8.8) at the time of first follow-up. The effect of CRP for symptom improvement was strongest within the first month after treatment (OR 4.1; 95% CI 3.1-5.2) with some decline thereafter (OR 2.8; 95% CI 1.7-3.9). Conversely, the ability of CRP to produce a negative Dix-Hallpike strengthened between the first month after treatment (OR 3.0; 95% CI 1.8-4.0) and later follow-up times (OR 5.0; 95% CI 3.9-6.1).
CONCLUSIONS: The CRP is more effective than control in resolving vertigo and positive Dix-Hallpike associated with BPPV. This finding was consistent among a variety of studies using different study designs. Untreated patients may demonstrate symptom improvement with time; however, many will continue to have a positive Dix-Hallpike when examined. Resolution of vertigo in untreated patients is therefore most likely because of avoidance of provocative positions.
T Imai, M Ito, N Takeda, A Uno, T Matsunaga, K Sekine, T Kubo
Natural course of the remission of vertigo in patients with benign paroxysmal positional vertigo.
Neurology. 2005 Mar 8;64(5):920-1. doi: 10.1212/01.WNL.0000152890.00170.DA.
Abstract/Text
The authors assessed the natural course of benign paroxysmal positional vertigo (BPPV) in 108 patients who were not treated with canalith repositioning procedure. The average number of days from onset to remission of positional vertigo in patients with posterior canal BPPV (P-BPPV) (39 days) was longer than in those with horizontal canal BPPV (H-BPPV) (16 days). The ratio of patients with H-BPPV to those with BPPV was 33%.
松吉秀武, 蓑田涼生, 湯本英二: 熊本県における良性発作性頭位眩暈症の検討. 耳鼻臨床 2008:101:905-912.
Janet Odry Helminski, David Samuel Zee, Imke Janssen, Timothy Carl Hain
Effectiveness of particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo: a systematic review.
Phys Ther. 2010 May;90(5):663-78. doi: 10.2522/ptj.20090071. Epub 2010 Mar 25.
Abstract/Text
BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo.
PURPOSE: The purpose of this systematic review was to determine whether patients diagnosed with posterior canal (PC) BPPV, based on positional testing, and treated with a particle repositioning maneuver will show the resolution of benign paroxysmal positional nystagmus (BPPN) on the Dix-Hallpike Test performed 24 hours or more after treatment.
DATA SOURCES: Data were obtained from an electronic search of the MEDLINE, EMBASE, and CINAHL databases from 1966 through September 2009.
STUDY SELECTION: The study topics were randomized controlled trials (RCTs), quasi-RCTs, the diagnosis of PC BPPV, treatment with the particle repositioning maneuver, and outcome measured with a positional test 24 hours or more after treatment.
DATA EXTRACTION: Data extracted were study descriptors and the information used to code for effect size.
DATA SYNTHESIS: In 2 double-blind RCTs, the odds in favor of the resolution of BPPN were 22 times (95% confidence interval=3.41-141.73) and 37 times (95% confidence interval=8.75-159.22) higher in people receiving the canalith repositioning procedure (CRP) than in people receiving a sham treatment. This finding was supported by the results reported in 8 nonmasked quasi-RCTs. Studies with limited methodological quality suggested that a liberatory maneuver (LM) was more effective than a control intervention; there was no significant difference in the effectiveness of the LM and the effectiveness of the CRP; the self-administered CRP was more effective than the self-administered LM; and the CRP administered together with the self-administered CRP was more effective than the CRP administered alone. The Brandt-Daroff exercises were the least effective self-administered treatments.
LIMITATIONS: The limitations included the methodological quality of the studies, the lack of quality-of-life measures, and confounding factors in reporting vertigo.
CONCLUSIONS: Randomized controlled trials provided strong evidence that the CRP resolves PC BPPN, and quasi-RCTs suggested that the CRP or the LM performed by a clinician or with proper instruction at home by the patient resolves PC BPPN. There were no data on the effects of the maneuvers on outcomes relevant to patients.
Takao Imai, Noriaki Takeda, Mahito Ito, Hidenori Inohara
Natural course of positional vertigo in patients with apogeotropic variant of horizontal canal benign paroxysmal positional vertigo.
Auris Nasus Larynx. 2011 Feb;38(1):2-5. doi: 10.1016/j.anl.2010.05.011. Epub 2010 Jun 29.
Abstract/Text
OBJECTIVE: The purpose of this study was to assess the natural course of positional vertigo in patients with the apogeotropic variant of horizontal canal type of benign paroxysmal positional vertigo (AH-BPPV), which is reported to be more refractory to physiotherapy than the geotropic variant of horizontal canal type of BPPV (GH-BPPV).
METHODS: 14 patients with AH-BPPV treated without physiotherapy were asked to visit the hospital every 2 weeks. At every follow-up visit, they were interviewed and positional nystagmus was assessed. After the disappearance of positional nystagmus, patients were asked about the time of cessation of the positional vertigo. Thus, the primary outcomes were evaluated by the self-reported onset and remission of positional vertigo. The time course of remission of positional vertigo was then calculated.
RESULTS: The average and median period from the onset to natural remission of positional vertigo in patients with AH-BPPV was 13 and 7 days, respectively.
CONCLUSION: We have already reported that the average and median period from the onset to natural remission of positional vertigo in patients with GH-BPPV was 16 and 7 days, respectively (Imai et al., 2005 [8]). Thus, the natural course of AH-BPPV is not as refractory as that of GH-BPPV.
Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
Malcolm P Hilton, Darren K Pinder
The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo.
Cochrane Database Syst Rev. 2014 Dec 8;(12):CD003162. doi: 10.1002/14651858.CD003162.pub3. Epub 2014 Dec 8.
Abstract/Text
BACKGROUND: This is an update of a Cochrane Review first published in The Cochrane Library in Issue 1, 2002 and previously updated in 2004 and 2007.Benign paroxysmal positional vertigo (BPPV) is a syndrome characterised by short-lived episodes of vertigo in association with rapid changes in head position. It is a common cause of vertigo presenting to primary care and specialist otolaryngology clinics. Current treatment approaches include rehabilitative exercises and physical manoeuvres, including the Epley manoeuvre.
OBJECTIVES: To assess the effectiveness of the Epley manoeuvre for posterior canal BPPV.
SEARCH METHODS: We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; CENTRAL; PubMed; EMBASE; CINAHL; Web of Science; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 23 January 2014.
SELECTION CRITERIA: Randomised controlled trials of the Epley manoeuvre versus placebo, no treatment or other active treatment for adults diagnosed with posterior canal BPPV (including a positive Dix-Hallpike test). The primary outcome of interest was complete resolution of vertigo symptoms. Secondary outcomes were conversion of a 'positive' Dix-Hallpike test to a 'negative' Dix-Hallpike test and adverse effects of treatment.
DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by The Cochrane Collaboration.
MAIN RESULTS: We included 11 trials in the review with a total of 745 patients.Five studies compared the efficacy of the Epley manoeuvre against a sham manoeuvre, three against other particle repositioning manoeuvres (Semont, Brandt-Daroff and Gans) and three against a control (no treatment, medication only, postural restriction). Patients were treated in hospital otolaryngology departments in eight studies and family practices in two studies. All patients were adults aged 18 to 90 years old, with a sex ratio of 1:1.5 male to female.There was a low risk of overall bias in the studies included. All studies were randomised with six applying sealed envelope or external allocation techniques. Eight of the trials blinded the assessors to the participants' treatment group and data on all outcomes for all participants were reported in eight of the 11 studies. Complete resolution of vertigo Complete resolution of vertigo occurred significantly more often in the Epley treatment group when compared to a sham manoeuvre or control (odds ratio (OR) 4.42, 95% confidence interval (CI) 2.62 to 7.44; five studies, 273 participants); the proportion of patients resolving increased from 21% to 56%. None of the trials comparing Epley versus other particle repositioning manoeuvres reported vertigo resolution as an outcome. Conversion of Dix-Hallpike positional test result from positive to negative Conversion from a positive to a negative Dix-Hallpike test significantly favoured the Epley treatment group when compared to a sham manoeuvre or control (OR 9.62, 95% CI 6.0 to 15.42; eight studies, 507 participants). There was no difference when comparing the Epley with the Semont manoeuvre (two studies, 117 participants) or the Epley with the Gans manoeuvre (one study, 58 participants). In one study a single Epley treatment was more effective than a week of three times daily Brandt-Daroff exercises (OR 12.38, 95% CI 4.32 to 35.47; 81 participants). Adverse effects Adverse effects were infrequently reported. There were no serious adverse effects of treatment. Rates of nausea during the repositioning manoeuvre varied from 16.7% to 32%. Some patients were unable to tolerate the manoeuvres because of cervical spine problems.
AUTHORS' CONCLUSIONS: There is evidence that the Epley manoeuvre is a safe, effective treatment for posterior canal BPPV, based on the results of 11, mostly small, randomised controlled trials with relatively short follow-up. There is a high recurrence rate of BPPV after treatment (36%). Outcomes for Epley manoeuvre treatment are comparable to treatment with Semont and Gans manoeuvres, but superior to Brandt-Daroff exercises.
Dae Bo Shim, Kyung Min Ko, Joon Hee Lee, Hong Ju Park, Mee Hyun Song
Natural history of horizontal canal benign paroxysmal positional vertigo is truly short.
J Neurol. 2015 Jan;262(1):74-80. doi: 10.1007/s00415-014-7519-0. Epub 2014 Oct 11.
Abstract/Text
The objective of the study is to characterize the natural course of positional vertigo and nystagmus in patients with horizontal canal benign paroxysmal positional vertigo (h-BPPV) and to analyze the difference in the natural course between the two variants of h-BPPV. We conducted a prospective study in 106 patients with geotropic type h-BPPV [h-BPPV (Geo)] (n = 43) and apogeotropic type h-BPPV [h-BPPV (Apo)] (n = 63) who agreed and signed the written informed consent of no treatment. All patients were asked to answer a detailed interview about the onset time of positional vertigo and to visit the hospital every 1-3 days. At every visit, they were interviewed about cessation time of positional vertigo and positional nystagmus was assessed. The mean period ± SD between the onset and remission of vertigo in the h-BPPV (Geo) was 6.7 ± 6.3 days, whereas that in the h-BPPV (Apo) was 3.7 ± 4.1 days. In addition, the mean period ± SD from the initial diagnosis to the disappearance of positional nystagmus in the h-BPPV (Geo) was 4.7 ± 3.9 days, whereas that in the h-BPPV (Apo) was 4.4 ± 5.0 days. Although the duration until natural remission of positional nystagmus did not differ between the two variants of h-BPPV, the remission of vertigo occurred faster in h-BPPV (Apo) than h-BPPV (Geo) (p < 0.05). The natural course of h-BPPV is much shorter than that indicated in previous reports. The positional vertigo disappeared faster in the h-BPPV (Apo) compared to the h-BPPV (Geo) unlike the positional nystagmus.
Kwanchanok Yimtae, Somchai Srirompotong, Supaporn Srirompotong, Patchareeporn Sae-Seaw
A randomized trial of the canalith repositioning procedure.
Laryngoscope. 2003 May;113(5):828-32. doi: 10.1097/00005537-200305000-00011.
Abstract/Text
OBJECTIVE: To compare the effectiveness and complications of our adaptation of the canalith repositioning procedure (CRP) with the expectation treatment for benign paroxysmal positional vertigo.
STUDY DESIGN: A randomized, controlled trial in the setting of a neurotological clinic in Thailand.
METHODS: Fifty-eight patients with posterior benign paroxysmal positional vertigo were randomly assigned to treatment and control groups using a block of four. The treatment group was treated with the modified CRP technique until the nystagmus disappeared. A mastoid oscillator was not used, nor were any instructions given for patients after the maneuver. Both groups recorded the daily grading of symptoms and the amount of anti-vertiginous drugs (cinnarizine) taken. Objective and subjective assessments were made weekly until the nystagmus disappeared or until 4 weeks had passed since treatment began.
RESULTS: The rates of effectiveness of CRP treatment and the control treatment for benign paroxysmal positional vertigo were 75.9% and 48.2%, respectively. There was a significant difference in the treatment outcomes of the CRP and control groups (P =.03). The CRP group used significantly fewer drugs than the control group (P =.001). Complications in the CRP group, such as lateral canalithiasis and fainting, were observed in 13.8% of the patients.
CONCLUSIONS: The CRP was more effective than the expectation treatment for benign paroxysmal positional vertigo insofar as it provided faster recovery and required less dependence on medication. Complications of CRP were limited to 13.8% of patients.
M von Brevern, T Seelig, A Radtke, K Tiel-Wilck, H Neuhauser, T Lempert
Short-term efficacy of Epley's manoeuvre: a double-blind randomised trial.
J Neurol Neurosurg Psychiatry. 2006 Aug;77(8):980-2. doi: 10.1136/jnnp.2005.085894. Epub 2006 Mar 20.
Abstract/Text
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.
Kazunori Sekine, Takao Imai, Go Sato, Mahito Ito, Noriaki Takeda
Natural history of benign paroxysmal positional vertigo and efficacy of Epley and Lempert maneuvers.
Otolaryngol Head Neck Surg. 2006 Oct;135(4):529-33. doi: 10.1016/j.otohns.2005.09.021.
Abstract/Text
We assessed the efficacy of Epley maneuver in patients with posterior canal benign paroxysmal positional vertigo (P-BPPV) and Lempert maneuver in patients with horizontal canal BPPV (H-BPPV). In patients with P-BPPV, positional vertigo in patients treated by Epley maneuver was significantly resolved more quickly than that in untreated patients. But in patients with H-BPPV, there were no significant differences of time course in remission of positional vertigo between untreated patients and patients treated by Lempert maneuver. Among the untreated patients, the positional vertigo in patients with H-BPPV was significantly resolved more quickly than that in patients with P-BPPV. Epley maneuver was effective for the treatment of patients with P-BPPV, whereas the efficacy of Lempert maneuver for the treatment of patients with H-BPPV was limited. The natural courses in remission of positional vertigo in untreated patients with H-BPPV showed significantly faster resolution than that in patients with P-BPPV.
Ying Chen, Jianhua Zhuang, Lin Zhang, Yancheng Li, Zhe Jin, Zhongxin Zhao, Ying Zhao, Hui Zhou
Short-term efficacy of Semont maneuver for benign paroxysmal positional vertigo: a double-blind randomized trial.
Otol Neurotol. 2012 Sep;33(7):1127-30. doi: 10.1097/MAO.0b013e31826352ca.
Abstract/Text
OBJECTIVE: To assess the short-term efficacy of Semont maneuver for unilateral posterior semicircular canal benign paroxysmal positional vertigo (PC-BPPV).
METHODS: The short-term efficacy of Semont maneuver was compared with a sham procedure in 128 patients with PC-BPPV by using a double-blinded prospective randomized controlled trial in the setting of a neurologic outpatient clinic in China. Analysis was based on the symptomatic status and the Dix-Hallpike maneuver on the fourth day. At this time, patients in both groups with a still positive Dix-Hallpike test were treated with Semont maneuver, and outcome was again assessed on the seventh day.
RESULTS: On the fourth day, 55 (84.62%) of 65 patients in the treatment group showed complete resolution of symptoms compared with 9 (14.29%) of 63 patients in the control group. (p < 0.001) 59 (90.77%) of 65 and 52 (82.54%) of 63 patients reported resolution of symptoms in the treatment and original sham group, respectively (p = 0.17).
CONCLUSION: Semont maneuver is shown to resolve PC-BPPV effectively, and patients should receive Semont maneuver once the PC-BPPV diagnosis was confirmed.
Jong Dae Lee, Dae Bo Shim, Hong Ju Park, Chan Il Song, Min-Beom Kim, Chang-Hee Kim, Jae Yong Byun, Sung Kwang Hong, Tae Su Kim, Kye Hoon Park, Jae-Hyun Seo, Byoung Soo Shim, Joon Han Lee, Hyun Woo Lim, Eun-Ju Jeon
A multicenter randomized double-blind study: comparison of the Epley, Semont, and sham maneuvers for the treatment of posterior canal benign paroxysmal positional vertigo.
Audiol Neurootol. 2014;19(5):336-41. doi: 10.1159/000365438. Epub 2014 Nov 1.
Abstract/Text
We evaluated the short-term efficacy of Epley, Semont, and sham maneuvers for resolving posterior canal benign paroxysmal positional vertigo (BPPV) in a prospective multicenter randomized double-blind controlled study. Subjects were randomly divided into three groups: Epley (36 patients), Semont (32 patients), and sham (Epley maneuver for the unaffected side, 31 patients). Out of 14 institutes which participated in this study, 5 institutes had previous experience of the Epley but not the Semont maneuver and the other 9 had previous experience of both maneuvers. Each maneuver was repeated twice if there was still positional vertigo or nystagmus on day 0, and the presence of nystagmus and vertigo on positional testing were evaluated immediately, 1 day, and 1 week after treatment. After the first maneuver, the Epley group showed a significantly higher resolution rate of positional nystagmus than the Semont or sham groups (63.9, 37.5, and 38.7%, respectively). After the second maneuver, the resolution rate (83.3%) of the Epley group was significantly higher than that (51.6%) of the sham group. At 1 day and 1 week after treatment, the resolution rate of the Epley group was significantly higher than those of the other groups. Similar results were seen for the resolution of positional vertigo. The Epley maneuver showed persistent resolution rates of positional vertigo and nystagmus without a fatigue phenomenon. The Epley maneuver was significantly more effective per maneuver than Semont or sham maneuvers for the short-term treatment of posterior canal BPPV. The Semont maneuver showed a higher success rate than the sham maneuver, but it was not significantly different.
© 2014 S. Karger AG, Basel.
D A Froehling, J M Bowen, D N Mohr, R H Brey, C W Beatty, P C Wollan, M D Silverstein
The canalith repositioning procedure for the treatment of benign paroxysmal positional vertigo: a randomized controlled trial.
Mayo Clin Proc. 2000 Jul;75(7):695-700. doi: 10.4065/75.7.695.
Abstract/Text
OBJECTIVE: To compare the canalith repositioning procedure (CRP) with a sham maneuver for the treatment of benign paroxysmal positional vertigo.
PATIENTS AND METHODS: We recruited 50 patients with a history of positional vertigo and unilateral positional nystagmus on physical examination (Dix-Hallpike maneuver). Patients were randomized to either the CRP (n = 24) or a sham maneuver (n = 26). Measured outcomes included resolution of vertigo and positional nystagmus at follow-up examination.
RESULTS: The mean duration of follow-up was 10 days for both groups. Resolution of symptoms was reported by 12 (50%) of the 24 patients in the CRP group and by 5 (19%) of the 26 patients in the sham group (P = .02). The results of the Dix-Hallpike maneuver were negative for positional nystagmus in 16 (67%) of 24 patients in the CRP group and in 10 (38%) of 26 patients in the sham group (P = .046).
CONCLUSION: The CRP is effective treatment of benign paroxysmal positional vertigo, and this procedure can be performed by general internists on outpatients with this disorder.
F Salvinelli, M Casale, M Trivelli, L D'Ascanio, L Firrisi, F Lamanna, F Greco, S Costantino
Benign paroxysmal positional vertigo: a comparative prospective study on the efficacy of Semont's maneuver and no treatment strategy.
Clin Ter. 2003 Jan-Feb;154(1):7-11.
Abstract/Text
PURPOSE: The present study investigates the efficacy of Semont's repositioning liberatory maneuver by comparing it with no-treatment in a population of patients with benign paroxysmal positional vertigo (BPPV).
MATERIALS AND METHODS: In this randomised, controlled, 6-month efficacy trial, 40 patients affected by BPPV were treated with Semont's maneuver. Outcomes were measured subjectively by patients about their Activities of Daily Living (ADL) and quality of life, based on the "Vestibular Disorders Activities of Daily Living Scale". Results were compared to those obtained in 40 non-treated BPPV patients.
RESULTS: During the first month of the study, 92.5% of patients of Semont's group resolved their symptoms. Cure rates with Semont's maneuver were significantly higher than those obtained with no-therapy (92.5% versus 37.5%). Within a six month follow-up, relapse rates were lower among patients treated with Semont's maneuver than among the no-treated ones (5% versus 60%). All patients with a resolution of symptoms and a negative Dix-Hallpike's test presented a great improvement in daily activities and quality of life.
CONCLUSIONS: BPPV is easy to solve with a successful repositioning maneuver. Since BPPV is a very common cause of vertigo and can represent a medical emergency, we believe that it is of interest for every general practitioner to be able to promptly recognize this frequent balance disorder and to be able to treat a patient affected by BPPV with a safe repositioning maneuver.
Tj D Bruintjes, J Companjen, H J van der Zaag-Loonen, P P G van Benthem
A randomised sham-controlled trial to assess the long-term effect of the Epley manoeuvre for treatment of posterior canal benign paroxysmal positional vertigo.
Clin Otolaryngol. 2014 Feb;39(1):39-44. doi: 10.1111/coa.12217.
Abstract/Text
OBJECTIVE: To evaluate the long-term efficacy of the Epley manoeuvre as a therapeutic procedure for posterior canal benign paroxysmal positional vertigo.
DESIGN: Randomised, double-blind, sham-controlled trial.
SETTING: A multidisciplinary dizziness unit in a non-academic Hospital.
PARTICIPANTS: Forty-four patients with posterior canal benign paroxysmal positional vertigo (BPPV) with a duration of at least 1 month. Participants were randomised in two groups of 22 and treated with either the Epley manoeuvre or a sham manoeuvre and followed up for 1 year after treatment.
MAIN OUTCOME MEASURES: Conversion of a 'positive' Dix-Hallpike test to a 'negative' Dix-Hallpike test, impairments perceived by the dizziness assessed by the Dizziness Handicap Inventory (DHI).
STATISTICAL ANALYSIS: Absolute and relative risks were computed, and Fisher's exact test was used to compare the treatments.
RESULTS: Six patients were lost to follow up (five in the sham group, one in the Epley group). The Epley procedure resulted in a treatment success in 20/22 patients (91%) after 12 months of follow-up, whereas the sham procedure had a positive effect in 10/22 patients (46%; P = 0.001). The DHI was significantly lower in the Epley group at all follow-up assessments (median scores 12 months 0 (0-51) versus 20 (0-76), P = 0.003).
CONCLUSION: The Epley manoeuvre provides long-term resolution of symptoms in patients with posterior canal BPPV.
© 2014 John Wiley & Sons Ltd.
José Luis Ballvé, Ricard Carrillo-Muñoz, Yolanda Rando-Matos, Iván Villar, Oriol Cunillera, Jesús Almeda, Estrella Rodero, Xavier Monteverde, Carles Rubio, Noemí Moreno, Olga Lucia Arias, Carlos Martin, Rafael Azagra
Effectiveness of the Epley manoeuvre in posterior canal benign paroxysmal positional vertigo: a randomised clinical trial in primary care.
Br J Gen Pract. 2019 Jan;69(678):e52-e60. doi: 10.3399/bjgp18X700253. Epub 2018 Dec 3.
Abstract/Text
BACKGROUND: Evidence on the effectiveness of the Epley manoeuvre in primary care is scarce.
AIM: To evaluate effectiveness at 1 week, 1 month, and 1 year of a single Epley manoeuvre versus a sham manoeuvre in primary care.
DESIGN AND SETTING: Multicentre, double-blind randomised controlled trial in two primary care practices in Spain from November 2012 to January 2015.
METHOD: Patients were ≥18 years diagnosed with subjective or objective posterior benign paroxysmal positional vertigo (vertigo only, or vertigo and nystagmus after a Dix-Hallpike test [DHT]). The intervention group received the Epley manoeuvre, and the control group received a sham manoeuvre. Betahistine was prescribed following the same regimen in both groups. The main outcome measures were the DHT result classified as negative (neither vertigo nor nystagmus) or positive. Positive results were further divided into a positive result for both vertigo and nystagmus (positive DHT with nystagmus), and a positive result for vertigo only (positive DHT without nystagmus); self-reported resolution of vertigo; and self-reported severity of vertigo evaluated on a 10-point Likert scale (10 = worst imaginable vertigo).
RESULTS: In total, 134 patients were randomised to either the intervention group (n = 66) or the sham group (n = 68). The intervention group showed better results in the unadjusted analyses at 1 week, with a lower rate of positive DHT with nystagmus (P = 0.022). A positive baseline DHT with nystagmus was associated with a reduction in vertigo severity (marginal effect for 10-point Likert-like question -1.73, 95% confidence interval [CI] = -2.95 to -0.51) and better positive DHT rates in the intervention group (adjusted odds ratio 0.09, 95% CI = 0.01 to 0.92) in the multivariate analyses.
CONCLUSION: A single Epley manoeuvre performed in primary care is an effective treatment for reversing a positive DHT and reducing vertigo severity in patients with baseline nystagmus in the DHT.
© British Journal of General Practice 2019.
高久史麿、杉町圭蔵、北村惣一郎、内山 充ほか監修：日本医薬品集医療薬 2019年版、じほう社、2018.
I Matsuoka, S Takaori, M Morimoto
Effects of diphenidol on the central vestibular and visual systems of cats.
Jpn J Pharmacol. 1972 Dec;22(6):817-25.
Abstract/Text
Wei Fu, Junliang Han, Ning Chang, Dong Wei, Ya Bai, Yuanyuan Wang, Feng He, Xiaoming Wang
Immediate efficacy of Gufoni maneuver for horizontal canal benign paroxysmal positional vertigo (HC-BPPV): a meta-analysis.
Auris Nasus Larynx. 2020 Feb;47(1):48-54. doi: 10.1016/j.anl.2019.05.002. Epub 2019 May 28.
Abstract/Text
OBJECTIVE: This meta-analysis aims to systematically measure the immediate efficacy of the Gufoni maneuver for horizontal canal benign paroxysmal positional vertigo (HC-BPPV).
METHODS: A extensive search electronic databases, including PubMed, Embase, Web of Science and Cochrane library, were searched until to September 1, 2018 for relevant articles. We selected only randomized clinical trials studying with treatment of HC-BPPV employ by the Gufoni maneuver.
RESULTS: Five randomized clinical trials were included in the current meta-analysis with a total of 714 HC-BPPV patients. The meta-analysis revealed that Gufoni maneuver had a higher immediate recovery rate than sham maneuver in treatment of HC-BPPV (risk ratio = 2.68, 95% CI, 1.54-4.65, p < 0.01). No difference was observed in immediate recovery rate between Gufoni maneuver and other maneuvers (risk ratio = 1.18, 95% CI, 0.99-1.41, p = 0.06). And Gufoni maneuver had a similar otolith switch rate with other maneuvers (risk ratio = 2.13, 95% CI, 0.56-8.07, p = 0.27).
CONCLUSION: Gufoni maneuver has a satisfactory immediate efficacy for HC-BPPV and does not increase otolith switch rate.
Copyright © 2019 Elsevier B.V. All rights reserved.
Emke Mechelina Josephina Margo van den Broek, Hester Josephine van der Zaag-Loonen, Tjasse Doewe Bruintjes
Systematic Review: Efficacy of Gufoni Maneuver for Treatment of Lateral Canal Benign Paroxysmal Positional Vertigo with Geotropic Nystagmus.
Otolaryngol Head Neck Surg. 2014 Jun;150(6):933-8. doi: 10.1177/0194599814525919. Epub 2014 Mar 13.
Abstract/Text
OBJECTIVE: In this rapid systematic review, we studied the efficacy of the Gufoni maneuver for the treatment of lateral canal benign paroxysmal positional vertigo (BPPV) with geotropic nystagmus.
METHODS: A comprehensive search, including PubMed, Embase, Web of Science, and Cochrane as data sources, resulted in 44 original papers for randomized trials that compared the Gufoni maneuver with other maneuvers (date of search: April 23, 2013). Three studies (389 patients) remained after screening of title, abstract, and full text.
RESULTS: After method assessment, 2 of these 3 studies were considered to have a low risk of bias and a high level of validity. The third study did not properly report the treatment allocation and blinding; moreover, outcome data were incomplete. The first 2 studies compared the Gufoni maneuver with a sham maneuver (and the barbecue roll in one study). The third study compared the Gufoni maneuver with a treatment with vestibular suppressants and with the barbecue roll (plus forced prolonged positioning). All 3 studies reported short-term results. Midterm results (1 month) were reported in 2 studies.
CONCLUSION AND RECOMMENDATION: Given the variety in the comparative treatments and follow-up duration, all 3 studies showed that the Gufoni maneuver was more effective than the sham maneuver or treatment with vestibular suppressants. All agreed that the maneuver was easy to perform, which made it suitable for older, immobile, and obese patients. However, there were insufficient data to establish the relative efficacy of the Gufoni maneuver compared with other maneuvers.
© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.
J-S Kim, S-Y Oh, S-H Lee, J-H Kang, D U Kim, S-H Jeong, K-D Choi, I-S Moon, B-K Kim, H J Oh, H J Kim
Randomized clinical trial for apogeotropic horizontal canal benign paroxysmal positional vertigo.
Neurology. 2012 Jan 17;78(3):159-66. doi: 10.1212/WNL.0b013e31823fcd26. Epub 2011 Dec 14.
Abstract/Text
OBJECTIVE: To determine the immediate and long-term therapeutic efficacies of Gufoni and head-shaking maneuvers in apogeotropic type of benign paroxysmal positional vertigo involving the horizontal semicircular canal (HC-BPPV), a randomized, prospective, sham-controlled study was conducted.
METHODS: In 10 nationwide dizziness clinics in Korea, 157 consecutive patients (95 women, age range: 18-89 years, mean age ± SD = 59.9 ± 13.6) with apogeotropic HC-BPPV were randomized to Gufoni (n = 52), head-shaking (n = 54), or sham maneuver (n = 51). For Gufoni maneuver, patients underwent ipsilesional side-lying and upward head-turn for migration of the debris toward the vestibule. Immediate responses were determined within 1 hour after a maximum of 2 trials of each maneuver and in the following day. The patients also had weekly follow-ups for 1 month after the initial maneuver.
RESULTS: After a maximum of 2 maneuvers on the initial visit day, Gufoni (38/52, 73.1%) and head-shaking (33/53, 62.3%) maneuvers showed better responses than the sham maneuver (17/49, 34.7%). The cumulative therapeutic effects were also better with Gufoni (p < 0.001) and head-shaking (p = 0.026) maneuvers compared with the sham maneuver. However, therapeutic efficacies did not differ between the Gufoni and head-shaking groups in terms of both immediate (p = 0.129) and long-term (p = 0.239) outcomes.
CONCLUSION: Using a prospective randomized trial, we demonstrated that the Gufoni and head-shaking maneuvers are effective in treating apogeotropic HC-BPPV.
CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that Gufoni and head-shaking maneuvers are effective in treating apogeotropic horizontal BPPV up to 1 month after initial treatment.
CLINICAL TRIAL REGISTRATION: NCT00810641.
Minho Hwang, Sang-Hoon Kim, Kyung-Wook Kang, Dasom Lee, Sae-Young Lee, Myeong-Kyu Kim, Seung-Han Lee
Canalith repositioning in apogeotropic horizontal canal benign paroxysmal positional vertigo: Do we need faster maneuvering?
J Neurol Sci. 2015 Nov 15;358(1-2):183-7. doi: 10.1016/j.jns.2015.08.1534. Epub 2015 Aug 28.
Abstract/Text
A correct diagnosis and a proper treatment may yield a rapid and simple cure for benign paroxysmal positional vertigo (BPPV). Although the Gufoni maneuver is widely used to treat apogeotropic horizontal-canal BPPV (HC-BPPV), few studies have clarified the relationship between the speed and intensity of maneuver execution and successful canalith reposition. To evaluate the effect of accelerated execution of the Gufoni maneuver, a prospective randomized controlled study was conducted with HC-BPPV patients in a single dizziness clinic. The patients had been diagnosed with apogeotropic HC-BPPV and were undergoing treatment at the dizziness clinic of a tertiary university hospital from January 2013 to August 2014. Two groups were treated with the maneuver performed at different speeds and the resolution rate was compared. The accelerated maneuver group was subjected to faster position changing-within 1s-during the reposition maneuver, while the non-accelerated maneuver group underwent slower maneuvers. Therapeutic efficacy was defined as dizziness relief or resolution of nystagmus within 1h. Fifty patients with apogeotropic HC-BPPV were enrolled and treated with the Gufoni maneuver in two groups of 25 patients. The overall resolution rate was 48% (24 of 50; p=1.00), regardless of acceleration. Our results suggest that a faster, more intense execution of the Gufoni maneuver provides little benefit in treating apogeotropic HC-BPPV. Detachment of the otolith from the cupula or the gravitational force-when the otolith is in the anterior arm of the HC-may be more important contributors to treatment efficacy.
Copyright © 2015 Elsevier B.V. All rights reserved.
