A randomised sham-controlled trial to assess the long-term effect of the Epley manoeuvre for treatment of posterior canal benign paroxysmal positional vertigo.

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.

[Intermittent swelling of the eyelid]. / Een intermitterende zwelling van het ooglid.

BACKGROUND: Mucoceles are benign mucous-containing cysts that can occur in the sinuses. They arise as a result of an obstruction of the sinus ostium. There is often a delay in diagnosis because symptoms are so variable. CASE DESCRIPTION: A 52-year-old woman had intermittent swelling of the eyelid. A CT scan of the sinuses showed a mucocele in the frontal sinus with breakthrough to the left orbit. Treatment consisted of marsupialisation by means of functional endoscopic sinus surgery with septum correction. CONCLUSION: Breakthrough of a mucocele to the orbit should be considered in the differential diagnosis in patients with an intermittent swelling of the eyelid.