benign positional vertigo treatment epley maneuver

We ensured that this study was PRISMA-compliant by consulting the PRISMA 2020 checklist (details provided in Additional file 1).

This study was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The study was registered in protocols.io (PROTOCOL INTEGER ID: 51,464).

Therefore, this study aimed to clarify the efficacy of EM for BPPV in primary-care and subspecialty settings. It is uncertain whether EM contributes adequately to the treatment of BPPV in the primary-care setting. In the 2014 Cochrane Review of EM for BPPV, 2 of the 11 trials were in primary-care settings, and the remainder were conducted in secondary or tertiary care in the otolaryngology departments. Furthermore, studies regarding the efficacy of EM in primary-care settings are rare. Several RCTs on the efficacy of EM on BPPV in primary-care settings have been published since 2014 however, the integrated results of these trials are not yet clear. EM was first described by Epley in 1992, and systematic review and meta-analysis with small-size randomised controlled trials (RCTs) in the 2014 Cochrane Review, including primary-care settings, showed the efficacy of EM for posterior canal BPPV. Regarding patients with BPPV, long-term follow-up studies have indicated that vestibular suppressants may not affect symptom resolution moreover, there is evidence that canalith repositioning procedures are superior to these drugs. There is high-quality and compelling evidence that patients diagnosed with posterior canal BPPV should be offered expeditious treatment with canalith repositioning procedures, commonly referred to as the Epley manoeuvre (EM).

Horizontal canal BPPV should be considered when horizontal nystagmus is seen rather than upbeat torsional nystagmus in the DH manoeuvre. The Dix–Hallpike (DH) manoeuvre is considered the gold standard test for the diagnosis of posterior canal BPPV. However, horizontal canal BPPV is probably much more common than previously recognised. The most common form of BPPV is the posterior semicircular canals, which account for 85% of cases. It’s characterized by repeated episodes of vertigo, which are triggered by rapid changes in head position. The study was registered in protocols.io (PROTOCOL INTEGER ID: 51,464) on July 11, 2021.īenign paroxysmal positional vertigo (BPPV) is a common inner ear disorder. EM for BPPV in a primary-care setting may aid in preventing referrals to higher tertiary care facilities and hospitalisation for follow-up. This study has shown the significance of performing EM for BPPV in primary-care settings. Regardless of primary-care and subspecialty settings, EM for BPPV was effective. The evidence exhibited uncertainty about the effect of EM on negative findings in primary-care settings and all adverse events in subspecialty settings. In the subspeciality setting, EM reduced the subjective symptoms (RR, 2.42 95% CI, 1.64–3.56), resulting in an increase in negative findings (RR, 1.81 95% CI, 1.40–2.34). In primary-care settings, EM reduced the subjective symptoms however, there was no applicable article for all adverse events.

Twenty-seven randomised controlled trials were identified. We evaluated the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach. Primary outcomes were the disappearance of subjective symptoms (vertigo), negative findings (Dix–Hallpike test), and all adverse events. A systematic search was conducted in January 2022 across databases, including Cochrane Central Resister of Controlled Trial, MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature, World Health Organization International Clinical Trials Registry Platform, and. A primary-care setting was defined as a practice setting by general practitioners, primary-care doctors, or family doctors. Systematic review and meta-analysis of randomised sham-controlled trials of EM for the treatment of posterior canal BPPV in primary-care and subspecialty settings. We conducted this systematic review and meta-analysis and clarified the efficacy of EM for BPPV, regardless of primary-care and subspecialty settings. Although previous studies have reported general inexperience with the Epley manoeuvre (EM) among general physicians, no report has evaluated the effect of EM on benign paroxysmal positional vertigo (BPPV) in primary care by using point estimates or certainty of evidence.

Benign positional vertigo treatment epley maneuver