Epley's Manoeuvre vs. Semont's Maneuver in Post-Canal Benign Paroxysmal Positional Vertigo: A Comparative Study in a Tertiary Centre.

Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder characterized by brief episodes of vertigo triggered by changes in head position. Epley's manoeuvre and Semont's manoeuvre are widely used canalith repositioning procedures for the treatment of BPPV. This study aimed to compare the effectiveness of these two manoeuvres in treating post-canal BPPV in a cohort of 100 patients. METHODS: This was a prospective, comparative study conducted at a tertiary care hospital. One hundred patients diagnosed with post-canal BPPV were randomized into two groups: Group A (n = 50) underwent the Epley's manoeuvre, and Group B (n = 50) underwent the Semont's manoeuvre. The patients were assessed for the resolution of vertigo and nystagmus immediately after the manoeuvre and at a follow-up visit one week later. The resolution of symptoms was confirmed through Dix-Hallpike test. RESULTS: In Group A, 46 patients (92%) reported complete resolution of vertigo immediately after Epley's manoeuvre, and 47 patients (94%) had no nystagmus on the Dix-Hallpike test at the one-week follow-up. In Group B, 42 patients (84%) reported complete resolution of vertigo immediately after Semont's manoeuvre, and 44 patients (88%) had no nystagmus on the DH test at the one-week follow-up. The difference in effectiveness between the two manoeuvres was not statistically significant (p > 0.05). CONCLUSION: Both Epley's manoeuvre and Semont's manoeuvre are effective in treating post-canal BPPV, with similar success rates. The choice of manoeuvre may depend on patient preference, clinician expertise, and other individual factors. Further studies with larger sample sizes are warranted to validate these findings and explore other potential factors influencing the outcomes of canalith repositioning manoeuvres in BPPV.

New- and early-onset benign paroxysmal positional vertigo after otologic surgery.

PURPOSE: To determine the frequency and clinical features of new- and early-onset benign paroxysmal positional vertigo (BPPV) after different otologic surgical operations with and without surgical drilling. METHODS: All unilateral otologic operations performed at the otolaryngology clinic of a tertiary university hospital between January 2021 and May 2023 were screened, and 437 adult cases were included in the study. Of these patients, those who were diagnosed with BPPV within the first month postoperatively were examined. RESULTS: The overall incidence of BPPV after otologic operations was 2.28% (10 out of 437 patients). This incidence was 3% (8/266 patients) in cases where a drill was used and 1.16% (2/171 patients) in those where a drill was not used. There was no significant difference between the two groups (p > 0.05). Clinical symptoms related to BPPV appeared on average in 13.3 ± 6.8 (range: 3-25) days following surgery and presented as canalolithiasis. All cases involved the posterior semicircular canal (SCC) on the operated side. In addition, one patient with a cochlear implant had involvement of both the posterior and lateral SCCs. All patients responded well to repositioning maneuvers during follow-up. CONCLUSION: Otologic surgery, especially operations involving drilling, is a potential risk factor for the development of BPPV. Postoperative BPPV, primarily presenting as canalolithiasis in the posterior SCC on the operated side, can be effectively managed with repositioning maneuvers. Clinicians should be vigilant for BPPV in patients experiencing vertigo/dizziness within four weeks following otologic surgery.

[Association between sleep disorders and vestibular vertigo].

Sleep disorders have a high comorbidity rate with vestibular diseases. The results of some small sample clinical studies have confirmed the effect of sleep deprivation on vestibular function. However, the mechanism of the effect of sleep disorder on vestibular system is still unclear. This article analyzes the possible mechanism of the effect of sleep disorders on vestibular function from the aspects of neuroanatomy and neurotransmitters, and summarizes the relationship between sleep disorder and benign paroxysmal positional vertigo, Meniere's disease, vestibular migraine and other diseases.

Partial Treatment During BPPV Diagnostic Maneuvers.

This study examines a case of lateral canal benign paroxysmal positional vertigo (BPPV) where the sequence of diagnostic positional maneuvers may have influenced the release of some canaliths into the utricle. Partial treatment during BPPV diagnostic maneuvers may complicate side identification during supine roll test, especially in canalolithiasis cases.

Impact of Epley's Manoeuvre on Quality of Life in Patients with Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo: A Pre- and Post-Treatment Analysis.

Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder, predominantly affecting the posterior semicircular canal (PSC), and significantly impacts the quality of life (QoL) of patients. This study assesses the effectiveness of Epley's manoeuvre in improving QoL in patients with PSC-BPPV. This prospective analytical study, conducted at a tertiary care centre from January 2021 to December 2022, included 93 adult patients diagnosed with PSC-BPPV via the Dix-Hallpike test. Participants were evaluated using the dizziness handicap inventory (DHI) and visual vertigo analogue score (VAS) at baseline and on days 3, 10, and 30 post-treatments with Epley's manoeuvre. Data analysis focused on changes in DHI and VAS scores to assess the impact of treatment. The cohort comprised 58.1% males and 41.9% females, with a significant majority over 50 years of age. Notably, 90% of patients reported improvement by the first follow-up. Both DHI and VAS scores showed a statistically significant decrease over the follow-up period (p < 0.05), indicating a reduction in perceived dizziness and visual vertigo symptoms post-treatment. Epley's manoeuvre effectively improves the QoL in patients with PSC-BPPV, as evidenced by significant reductions in DHI and VAS scores. This study contributes to the evidence supporting Epley's manoeuvre as a key intervention in PSC-BPPV treatment, emphasizing its role in enhancing patient outcomes in clinical practice.

Diagnosis of Benign Paroxysmal Positional Vertigo Using a Questionnaire in a Hospital Based Rural Setting in India.

To develop and validate a simple questionnaire for the diagnosis of Benign Paroxysmal Positional Vertigo (BPPV) and also to accurately predict the involved side in BPPV. Patients (N = 148) who presented with dizziness to the ENT department were asked to fill out a questionnaire which was formulated to diagnose BPPV and the affected side. Five questions were part of the questionnaire. The fifth question was set to ascertain the affected side in BPPV. All the patients underwent a detailed neuro-otological examination and the findings were noted. The findings of the examination were correlated with the questionnaire findings. The mean age of the patient group was 54.72 years of age. The sensitivity of the questionnaire in detecting BPPV was 94.5%, though in 12.79% (n = 11) the side was not predicted correctly. The specificity of the questionnaire was 91.22%. The positive predictive value of the questionnaire in detecting BPPV was assessed at 94.5%.The questionnaire can be effectively used in predicting BPPV amongst patients presenting with dizziness and thus helps in avoiding unnecessary imaging and referrals to higher centres in view of suspicion of central causes of dizziness.

Enhancing BPPV Treatment Outcomes: A Comparative Study of the Epley Maneuver with and without the Dizzy-Fix Training Device.

INTRODUCTION: This study evaluates the effectiveness of combining the Epley Maneuver with the Dizzy-Fix Training Device in treating Benign Paroxysmal Positional Vertigo (BPPV), aiming to enhance treatment outcomes and patient satisfaction. METHODS: In this randomized controlled trial, 50 patients diagnosed with posterior canal BPPV were allocated into two groups: one receiving the traditional Epley Maneuver and the other undergoing the Epley Maneuver supplemented with the Dizzy-Fix Training Device. Key measures included the proportion of symptom-free patients at one month, changes in the Visual Analogue Scale (VAS) and Dizziness Handicap Inventory (DHI) scores, the recurrence rate within one month, and patient satisfaction. RESULTS: The Dizzy-Fix group achieved a significantly higher symptom resolution rate by day 7 (90% vs. 60%) and reported greater patient satisfaction (4.5/5 vs. 3.8/5) compared to the Epley Maneuver alone group. Additionally, this group exhibited a more substantial decrease in DHI scores (from an average of 30 to 5) and a lower recurrence rate (10% vs. 40%) within the first month post-treatment. CONCLUSION: Incorporating the Dizzy-Fix Training Device with the Epley Maneuver significantly improves the management of BPPV, evidenced by faster symptom resolution, enhanced patient satisfaction, and reduced symptom recurrence. These findings underscore the value of integrating real-time visual feedback technologies in vestibular rehabilitation, promising better patient outcomes, and advancing the quality of care in BPPV treatment.

A Study of Quality of Life Improvement in Videonystagmography Guided Epley's Manoeuvre in Posterior Canal Benign Paroxysmal Positional Vertigo.

To assess Quality of life improvement in Videonystagmography guided Epley's Manoeuvre in posterior canal benign paroxysmal positional vertigo. The design of present study is cross-sectional analytical study. The study is conducted in the Department of Otorhinolaryngology, Sri Aurobindo Medical College and Post Graduate Institute, Indore in association with Sri Aurobindo Institute of speech and hearing, Indore. Current study done to assess the effectiveness of canalolith repositioning procedures (Epley's maneuver) with and without drug therapy in posterior canal benign paroxsymal positional vertigo and to assess the patients based on Dizziness Handicap Inventory. All Patients who come to ENT OPD at Sri Aurobindo Medical College and Post Graduate Institute, Indore in the specified duration and according to the inclusion criteria were chosen in the study. Majority of the patients were in the age group of 18-58 years with the median age of 32 and subjective symptomatic relief on Epley's manoeuvre and DHI on day 15, 46 out of 60 subjects reported symptomatic relief with a percentage of 76.6%. This group of 46 subjects with symptomatic relief was labeled as resolved group. The age range in resolved group was between 18 and 58 years. Remaining 14 subjects, labelled as relapsed group were prescribed beta-histine and repeat Epley's maneuver was performed to assess the effectiveness of adjunct therapy. We conclude that a single Videonystagmography guided Epley's maneuver is an excellent tool for effective rehabilitation of majority of posterior canal BPPV alone and combined with adjunct betahistine therapy can even cure refractory cases providing them with better quality of life.

Adoption of the international classification of vestibular disorders criteria in cases of Benign positional paroxysmal vertigo: a single-center experience.

INTRODUCTION: Benign positional paroxysmal vertigo (BPPV) stands as the commonest cause for vertigo. It accounts for 20% of all cases of vertigo, even with its high prevalence rate it often goes underdiagnosed and undertreated. Development of the consensus document by the Bárány society's International Classification of Vestibular Disorders (ICVD)significantly facilitates the diagnosis of BPPV and its variants. This study assesses the utilisation of ICVD criteria for managing BPPV. METHODOLOGY: This is a cross-sectional descriptive study conducted at a tertiary care hospital in Northern India spanning from November 1, 2022, to November 30, 2023. A total of 110 participants diagnosed with BPPV were enrolled consecutively. All participants underwent Dix-Hallpike and supine log roll positional maneuvers. Diagnosis was made based on the history and type of nystagmus seen, and classified as per the ICVD criteria. RESULTS: Posterior semicircular canalolithiasis (pc-BPPV) accounted for 25.45% of cases and horizontal canal canalolithiasis (hc-BPPV) accounted for 20.91% of cases. Probable BPPV, spontaneously resolved (pBPPVsr) was diagnosed in 16.36% of participants and possible BPPV(pBPPV) was diagnosed in 18.18% of participants. Multiple canal BPPV (mc-BPPV) accounted for 17.27% of cases. One participant was diagnosed with horizontal canal cupulolithiasis and anterior canal canalolithiasis respectively. No participant was diagnosed with posterior canal cupulolithiasis. CONCLUSION: The most common type of BPPV was pc-BPPV followed by hc-BPPV. The affected canal in possible BPPV, can be identified, and appropriate repositioning maneuvers are effective in treating them as well as aids in confirming the diagnosis. The diagnostic clarity provided by ICVD, aids in effective management of BPPV. More studies with larger sample size are required to further validate its clinical utility.

The Impact of Serums Calcium 25-Hydroxy Vitamin D, Ferritin, Uric Acid, and Sleeping Disorders on Benign Paroxysmal Positional Vertigo Patients.

OBJECTIVE: This study's objective was to identify the factors and impact of serums calcium 25-Hydroxy vitamin D, ferritin, uric acid, and sleeping disorders on benign paroxysmal positional vertigo (BPPV) patients. METHODS: This is a case and control design study. The consecutive patients' visits (age, older than 25 years) with idiopathic BPPV were recruited in the present study. For each patient, 3:1 sex and age-matched healthy people were assigned as the control. The study comprised 177 patients with BPPV and 656 controls. The study included biochemical, clinical, physical examinations, PSQI sleep quality, supine roll test, and Dix-Hallpike test for the diagnosis of all patients, and pure-tone audiometry (PTA) was used to assess hearing. Univariate and multivariate stepwise regression analyses were used for statistical analysis. RESULTS: The study comprised 833 patients with 295 males (35.4%) and 538 females (64.6%) who were between 25 and 70 years old. Of a total of 833 participants, 177 were BPPV patients, and 656 subject were normal. The results shown that there were significant differences between the BPPV and the normal group in terms of BMI (p = 0.039), physical activity (p = 0.003), cigarette smoking (p = 0.035), nargile-waterpipe use (p < 0.001), diabetes (p < 0.001), hypertension (p < 0.001), congestive heart failure (CHF) (p < 0.001), neurology (p < 0.001), tinnitus (p < 0.001), dizziness (p < 0.001), headache (p < 0.001), vitamin D (p = 0.004), calcium (p = 0.004), magnesium (p < 0.001), potassium (p = 0.019), phosphorus (p < 0.001), haemoglobin (p < 0.001), serum glucose (p < 0.001), HbA1c (p < 0.001), triglyceride (p < 0.001), systolic BP (p = 0.004), diastolic BP (p = 0.008), and microalbuminuria (p = 0.005); ATP III metabolic syndrome (p = 0.038), IDF metabolic syndrome (p = 0.034), and poor sleep (p = 0.033). In terms of the type of BPPV, the posterior canal was the most commonly affected (n = 126, 71.2%), followed by the horizontal (n = 43, 24.3%) and anterior canal (n = 8, 4.5%). The analysis indicated that serum ferritin (p < 0.001), uric acid (p < 0.001), blood pressure (p < 0.001), dizziness (p < 0.001), cigarette-water-pipe smokers (p = 0.004), headaches/migraines (p = 0.005), calcium (p = 0.007), vitamin D deficiency (p = 0.008), sleepiness (p = 0.016), physical activity (p = 0.022), CHF (p = 0.024), and tinnitus (p = 0.025) were considered as risk predictors for BPPV. CONCLUSIONS: The results revealed that the serum levels of vitamin D, ferritin, uric acid, and calcium are low among the study population and supplementation could be considered as prevention in BPPV patients.

A novel seated repositioning maneuver for geotropic lateral canal BPPV: efficacy and technique.

PURPOSE: This study introduces and evaluates the sitting lateral canal maneuver (SLCM), a novel seated repositioning technique for treating geotropic lateral canal benign paroxysmal positional vertigo (BPPV). METHODS: We conducted a retrospective chart review at the Hospital of Salerno, focusing on 26 patients diagnosed with geotropic LC-BPPV between 2021 and 2022. The SLCM was applied, and its efficacy was assessed based on the resolution of nystagmus and vertigo symptoms. A 95% confidence interval was calculated to estimate the success rate. RESULTS: The SLCM demonstrated a high success rate, with 22 out of 26 patients (approximately 85%, 22/26 patients) showing positive outcomes. The 95% confidence interval for the success rate ranged from approximately 65.02-100%. These findings suggest that SLCM is a potentially effective intervention for LC-BPPV, especially beneficial for patients who find traditional supine or lateral maneuvers uncomfortable. CONCLUSION: The SLCM represents a promising alternative to traditional BPPV maneuvers, especially for patients requiring a seated approach. While the initial results are encouraging, further research with larger sample sizes and longer follow-up periods is needed to validate its efficacy and explore its full potential in the management of LC-BPPV. LEVEL OF EVIDENCE: This study represents a Level IV source of evidence, as defined by the evidence-based practice guidelines. It is a retrospective chart review that involves a moderate cohort of patients diagnosed with geotropic horizontal positional nystagmus consistent with lateral canal benign paroxysmal positional vertigo (LC-BPPV). While the study provides valuable insights into the efficacy of the sitting lateral canal maneuver (SLCM) and contributes to the existing literature on BPPV management, it is important to note the inherent limitations associated with this level of evidence.

Gufoni maneuver for treatment of horizontal canal benign paroxysmal positional vertigo: a systematic review of randomized controlled trials.

PURPOSE: This review aims to investigate the effects of the Gufoni maneuver on horizontal semicircular canal benign paroxysmal positional vertigo (HC-BPPV). METHODS: A comprehensive search, including PubMed, PEDro, REHABDATA, SCOPUS, EMBASE, and Web of Science, was conducted to determine randomized clinical trials (RCTs) studying the effects of the Gufoni maneuver for HC-BPPV from inception to March 1, 2024. The quality of the included studies was estimated using the Physiotherapy Evidence Database (PEDro) scale. RESULTS: Ten randomized controlled trials (RCTs) were included in this review with a total of 1025 HC-BPPV patients (mean age = 58.58 years; 63% female; 55% right-side HC-HBPPV; 49% geotropic HC-BPPV). The included RCTs ranged from 4 to 9 out of 10 (median = 6.5) on the PEDro scale. The included studies showed that the Gufoni maneuver revealed efficacy when compared to the sham maneuver but not when compared to other maneuvers such as the Barbecue roll maneuver, the Appiani maneuver, the Mastoid oscillation, the head shaking, and the modified Gufoni maneuver. CONCLUSIONS: The Gufoni maneuver is considered an option for treating patients with geotropic or apogeotropic HC-BPPV. Precise diagnosis of the BPPV, the subtype of HC-BPPV, symptom duration, history of previous BPPV attacks, the applied methods of maneuver and the proficiency of the clinician performing the maneuver, proper diagnosis, presence of any underlying health conditions are critical for successful treatment. Further studies are strongly warranted.

Anxiety characteristics in benign paroxysmal positional vertigo: first vs. recurrent episodes.

PURPOSE: To assess the difference in state and trait anxiety levels in patients with Benign Paroxysmal Positional Vertigo (BPPV) at the first episode (FE) versus recurrent episodes (RE), before and after vestibular physiotherapy. A secondary objective was to assess the difference in the prevalence of underlying health conditions between FE and RE BPPV patients. METHODS: Fifty-five patients with BPPV, aged 40-70, were recruited. The diagnosis of BPPV was confirmed based on subjective complaints of vertigo and positive results from the Dix-Hallpike and Supine Roll tests. Twenty-four patients were in their FE, and 31 had RE. All patients completed the State-Trait Anxiety Inventory (STAI) questionnaire three times; before, immediately after, and a week after vestibular physiotherapy treatment. RESULTS: The RE group demonstrated higher trait anxiety than the FE group in all testing points: before treatment (median value of 38 versus 29, p-value = 0.02), immediately after treatment (median value of 36 versus 28, p-value < 0.01) and a week later (median value of 38 versus 28, p-value < 0.01). State anxiety decreased immediately after treatment in both groups, but at the second session, it was significantly higher in the RE than in the FE group (median value of 38 versus 28.5, p-value = 0.03). Hypothyroidism was significantly more frequent in the RE group (RE 16%, FE 0%, p-value = 0.04). CONCLUSIONS: Based on the current study's findings, we recommend assessing anxiety levels in patients with recurrent BPPV and consider referring them for appropriate treatment when necessary.

[Discussion and analysis the value of supine median³ nystagmus in the diagnosis and treatment of HC-BPPV].

Objective:To explore the clinical value of supine median³ nystagmus in the accurate diagnosis of horizontal semicircular canal benign paroxysmal positional vertigo（HC-BPPV）. Methods:A total of 187 patients with HC-BPPV admitted to the First Affiliated Hospital of Xi'an Jiaotong University from June 2020 to March 2021 were selected. Among them 42 cases of Cupulolithiasis and 145 cases of Canalithiasis. The nystagmus parameters of patients left and right supine position and supine median³ position were recorded in detail by RART. According to the direction of supine median³ nystagmus, patients were divided into three groups: group A（nystagmus to weak side）, group B（nystagmus to strong side）, group C（negative nystagmus）. The canalith repositioning manoeuvres（CRM） was carried out by utility of an automatic vestibular function diagnosis and therapy system（SRM-IV）. The cure rate of CRM in three groups of HC-BPPV patients was compared, Multivariate logistic regression analysis was performed to analyze the influencing factors of CRM for HC-BPPV. Results:The cure rates of group A, group B and group C were 81.58%, 16.13% and 56.25%, respectively. The difference among the three groups was statistically significant. Then a pairwise comparison of group A, B and C, the difference was statistically significant（χ²A-B=40.294,P<0.001,χ²B-C=14.528, P<0.001,χ²A-C=11.606, P=0.001）; the results of multivariate logistic regression analysis showed that the direction of supine median³ nystagmus and BMI were the influencing factors of CRM for HC-BPPV. Conclusion:The direction, intensity and duration of supine median³ nystagmus play an important role in determining the responsibility semicircular canal of HC-BPPV.

[Analysis of inducement of benign paroxysmal positional vertigo].

Objective:To analyze the related factors that may affect the onset of benign paroxysmal positional vertigo（BPPV）. Methods:Fifty BPPV patients treated in Department of Otolaryngology Head and Neck Surgery, Shanxi Provincial People's Hospital from May to September 2023 were selected as the case group, and 50 healthy adults were selected as the control group. Relevant information was collected by means of questionnaire survey and medical history inquiry. The two groups were compared in terms of sleep time, night sleep duration, wake times, underlying diseases（hypertension, diabetes, coronary heart disease, etc.） and negative emotional impact. Results:The proportion of male and female in the case group was 16% and 84%, and that in the control group was 20% and 80%. The mean age of the case group was（54.66±13.39） years old, and the mean age of the control group was（54.42±12.55） years old, ranging from 27 to 80 years old. The sleeping time of the case group was significantly later than that of the healthy group, and the difference was statistically significant（P<0.05）. The night sleep duration of the case group was shorter than that of the healthy group, the difference was statistically significant（P<0.05）. There was no significant difference in awakening times between the case group and the healthy group（P>0.05）. There were more patients in the case group with underlying diseases（54%） and affected by negative emotions（70%） than in the healthy group, and the difference was statistically significant（P<0.05）. Conclusion:Late sleep time, short sleep duration at night, accompanied by underlying diseases and negative emotions can affect the onset of BPPV.

To compare the recovery rates of modified Epley's against Semont's manoeuvres in patients with posterior canal benign paroxysmal positional vertigo: a randomized clinical trial.

INTRODUCTION: Benign paroxysmal positional vertigo (BPPV) is one of the commonest causes of peripheral vertigo. It is treated with various canalolith repositioning manoeuvres by changing the head positions to allow the otoconial debris to fall back from the affected canal back to the utricle. The present study has compared the rate of recovery of vertigo with modified Epley's manoeuvres as compared to Semont's manoeuvre in patients with posterior canal BPPV. MATERIALS AND METHODS: One hundred and seventy patients diagnosed by positive Dix-Hallpike test as posterior canal BPPV were included in this clinical trial. Subjective analysis of vertigo was done using visual analogue scale. 85 patients each were recruited in two arms by simple randomization using lottery method. Modified Epley's manoeuvre was administered to one group and Semont's manoeuvre to the other. They were recalled after 2 weeks for clinical assessment with repeat Dix-Hallpike and VAS. RESULTS: Repeat Dix-Hallpike manoeuvres after two weeks revealed that 95.3 and 90.6% patients improved in Modified Epley's and Semont's group, respectively. After the second manoeuvre, the resolution rate was significantly higher in Semont's manoeuvre 100% (8 out of 8 patients), as compared to 25% (1 out of 4 patients) in Modified Epley's manoeuvre. Comparison of the mean values of VAS day 0 and VAS 2 weeks has been found to be statistically significant (p value of < 0.001). CONCLUSION: Both Epley's and Semont's manoeuvre are equally efficacious in treatment of BPPV. However, use of Semont's manoeuvre required fewer repeat manoeuvres for complete resolution of symptoms in patients. The Semont's manoeuvre is also comparatively easier to perform with less number of position changes, takes less time, and has no requirement of post-manoeuvre mobility restrictions. Hence, it is recommended that Semont's manoeuvre can be routinely used for the management of PC BPPV especially in older population and patients with spinal problems.

Semont maneuver for posterior canal benign paroxysmal positional vertigo: a systematic review of randomized controlled trials.

PURPOSE: This review aimed to examine the effects of the Semont maneuver on posterior canal benign paroxysmal positional vertigo (BPPV). METHODS: PubMed, PEDro, SCOPUS, REHABDATA, EMBASE, and Web of Science were searched comprehensively from inception to January 2024. The Physiotherapy Evidence Database (PEDro) scale was employed to evaluate the quality of the selected studies. RESULTS: In total, 18 randomized controlled trials met the eligibility criteria. A total of 2237 participants with BPPV (mean age = 58.10 years) were included in this review. Among them, 37.5% were males, and 58% presented with right-sided BPPV. The included studies ranked from 5 to 9 out of 10 (Median = 7), suggesting good to excellent quality on the PEDro scale. The available literature revealed that the Semont maneuver is effective in improving posterior canal BPPV symptoms. CONCLUSION: The Semont maneuver is considered a standard option for treating posterior canal BPPV, with a high success rate of around 80%. It is suggested as the primary option for managing posterior canal BPPV in individuals who complain of cervical or lumbar problems, severe cardiac or respiratory conditions. Further studies are strongly needed to understand the long-term effects of the Semont maneuver and to identify the recurrence rate.

Comparing Epley Maneuver, Betahistine, and Dimenhydrinate in the Treatment of Benign Paroxysmal Positional Vertigo: A Prospective Study.

Although the Epley maneuver is considered the primary treatment in BPPV, anti-vertigo medications are effective in residual symptoms. This study was designed to compare betahistine and dimenhydrinate plus the Epley maneuver and the Epley maneuver alone. This prospective cohort study was performed in Mashhad, Iran, from 2013 to 2015. 90 adult patients diagnosed with BPPV in hospitals and ENT clinics were selected through convenience sampling. Patients received betahistine 8 mg TDS or dimenhydrinate 50 mg once daily plus Epley or the Epley alone for four weeks. SF-36 and the DHI were used before and after the treatment. 49 were females (54.4%). The mean (SD) age was 47.9 (8.7) years. There was no significant difference between the groups in age (P = 0.753) and gender (P = 0.050).There were significant differences in all areas of SF-36 except for social activities in the dimenhydrinate group. There was a marginally significant difference between the betahistine and dimenhydrinate groups in role limitation due to physical health problems (P = 0.046). There were significant differences between the females and males in emotional well-being before and after treatment in the dimenhydrinate group (P = 0.014) and in terms of role limitation due to physical health problems in the Epley maneuver group (P = 0.022). Older patients in the betahistine group had better social activities after treatment (P = 0.048). In severe forms of BPPV, betahistine or dimenhydrinate might effectively reduce the symptoms.

Positional nystagmus is observed in the vast majority of healthy individuals.

INTRODUCTION: Benign paroxysmal positional vertigo (BPPV) is a vestibular disease characterized by brief  positional vertigo. When examined, characteristic patterns of positional nystagmus (PN) are found with specific head position changes. Previous studies have shown a high prevalence of PN among vestibular healthy subjects. Considering the current diagnostic criteria of BPPV and the potentially high prevalence of PN in healthy individuals, this raises the question of potential over diagnosing BPPV, if diagnostics are based exclusively upon objective findings. This study aims to determine the prevalence of PN within a healthy, adult population and furthermore include a characterization of the PN observed. METHODS: This is a prospective cross-sectional study. 78 subjects were included. The subjects underwent four standardized positional tests for BPPV in a mechanical rotational chair while using a VNG-goggle to monitor and record eye movements. RESULTS: Positional nystagmus was recorded in 70.5% (55/78) of the subjects. Of the 55 subjects, who presented with PN, 81.8% (45/55) had upbeating PN. The 95th percentile of the maximum a-SPV was found to be 10.4 degrees per second, with a median of 4. Five subjects (6.4%) in total presented with PN mimicking BPPV. CONCLUSION: This study found PN to be a common finding within a healthy, adult population based on the high prevalence of PN in the study population. Upbeating PN mimicking posterior canalolithiasis was found in numerous subjects. The authors recommend a cautious approach when diagnosing BPPV, especially in cases of purely vertical PN (without a torsional component) and if no vertiginous symptoms are present during Dix-Hallpike and Supine Roll Test examinations.

Effectiveness of brandt-daroff exercises in the treatment of benign paroxysmal positional vertigo: a systematic review of randomized controlled trials.

PURPOSE: This review aims to examine the effects of Brandt-Daroff exercises (BDEs) on individuals with posterior canal Benign Paroxysmal Positional Vertigo (BPPV) and to provide recommendations for future research on this topic. METHODS: PubMed, MEDLINE, PEDro, SCOPUS, REHABDATA, EMBASE, and Web of Science were searched from inception to November 2023. The Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of the included studies. RESULTS: In total, ten randomized controlled trials met our eligibility criteria. A total of 880 individuals with BPPV (63.6% females) were included in this review. The included studies were ranked "good quality" on the PEDro scale. The available literature showed that BDEs do not significantly reduce symptoms or promote recovery in people with posterior canal BPPV compared to other interventions, such as Epley and Semont maneuvers. CONCLUSIONS: The evidence for the effects of BDEs on patients with BPPV is limited. Further high-quality studies with long-term follow-ups are strongly required to investigate the long-term effects of BDEs in posterior canal BPPV, define the optimal application of BDEs, and identify the factors associated with treatment response and recovery.