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The Epley Manoeuvre: Potential benefit for the treatment of vertigo

General | June 24, 2015 | Author: The Super Pharmacist

ENT, general

The Epley Manoeuvre: Potential benefit for the treatment of vertigo

The Epley manoeuvre is one of the principal treatments for benign paroxysmal positional vertigo or BPPV. The goal of the Epley manoeuvre is to reposition stones/debris within the semicircular canal in the inner ear. The manoeuvre can be performed by a professional, or a modified version can be done by the patient themselves.

Efficacy of the Epley Manoeuvre

If performed correctly and in people who truly have BPPV, the Epley manoeuvre is quite effective. The initial paper on the manoeuvre, originally called Canalith Repositioning Procedure by Dr. Epley, listed a success rate of 100% in 30 patients treated. Of that original group, 10% (three people) had some additional problem beyond BPPV that caused the vertigo. An additional 30% had their vertigo recur at some point, but all of whom responded to repeated treatments with the Epley manoeuvre. The Epley manoeuvre has been studied rather extensively over the past two decades and results consistently show that the manoeuvre is effective when compared to placebo. In fact, the modified Epley manoeuvre appears to be superior to other repositioning treatments of BPPV, specifically the Sermont manoeuvre and Brandt-Daroff exercises. Research also suggests that the Epley manoeuvre is more effective than anti-vertigo drug treatments. The number of people “cured” (i.e., no symptoms of vertigo or nystagmus) after one week range between 75 and 95% across studies. In one large study of nearly 1000 patients, 85% had immediate symptom relief and only 2% of those treated required more than three rounds of the Epley manoeuvre. People treated with the Epley manoeuvre are an astounding 37 times more likely to recover from BPPV then people treated with a sham manoeuvre.

Safety of the Epley Manoeuvre

Despite numerous clinical trials investigating the efficacy or effectiveness of the Epley manoeuvre, remarkably few have directly examined its safety. Nonetheless, some of the efficacy studies have commented on the safety of the manoeuvre indirectly. Of those papers, most authors agree that the Epley manoeuvre is quite safe. In fact, a large meta-analysis of studies documented that there were no serious adverse effects of treatment with the Epley manoeuvre across hundreds of patients treated. Some patients are unable to tolerate the manoeuvre because of problems with the neck and cervical spine, but this is not directly related to the safety of the manoeuvre, but rather a contraindication for the manoeuvre. The most common adverse effect of the Epley manoeuvre is nausea, which occurs during the repositioning exercises. Across studies, the rates of nausea varied between 16% and 32%. While it was not directly studied, the safety of the Epley maneuver appears to be the same whether performed by a medical professional or by the patient themselves.

How Long Must I Perform the Epley Manoeuvre to Achieve Results?

As with any medical treatment, individual results from performing the Epley manoeuvre will vary from patient to patient. That said, the majority of individuals with true BPPV will respond to the Epley manoeuvre within one week. Most sources recommend performing the Epley manoeuvre three times a day, each day until you are free from positional vertigo for a full 24 hours. Most people will experience immediate symptom relief (one day of treatment) and almost all will be symptom free by the end of the first week. A minority of people may benefit from the Epley manoeuvre initially only to have symptoms return weeks to months later. Fortunately, most people with the recurrence can still achieve success with the Epley manoeuvre if used again when symptoms return. If you do not experience benefit from the Epley maneuver within one week, especially if attempting to perform the treatment yourself (without the guidance of a professional) you may be experiencing a form of vertigo in addition to or separate from BPPV. If this is the case, you should consult a neurologist or and otolaryngologist (ear, nose, and throat specialist).

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References

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Fujino A, Tokumasu K, Yosio S, Naganuma H, Yoneda S, Nakamura K. Vestibular training for benign paroxysmal positional vertigo. Its efficacy in comparison with antivertigo drugs. Arch Otolaryngol Head Neck Surg. May 1994;120(5):497-504.

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McClure JA, Willett JM. Lorazepam and diazepam in the treatment of benign paroxysmal vertigo. J Otolaryngol. Dec 1980;9(6):472-477.

Prokopakis E, Vlastos IM, Tsagournisakis M, Christodoulou P, Kawauchi H, Velegrakis G. Canalith repositioning procedures among 965 patients with benign paroxysmal positional vertigo. Audiol Neurootol. 2013;18(2):83-88. doi:10.1159/000343579

Helminski JO, Zee DS, Janssen I, Hain TC. Effectiveness of particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo: a systematic review. Phys Ther. May 2010;90(5):663-678. doi:10.2522/ptj.20090071

Hilton MP, Pinder DK. The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database Syst Rev. 2014;12:CD003162. doi:10.1002/14651858.CD003162.pub3

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