Comparison of Repetitive Modified Epley’s manoeuvre in single sitting vs. thrice daily In Refractory Benign Paroxysmal Positional Vertigo.

Abstract

Introduction: Benign paroxysmal positional vertigo (BPPV) was recognized by Robert Barany in 1921. It is the commonest cause of peripheral vertigo presenting to vertigo clinics. Among several treatment modalities, Epley manoeuvre carries a 90.7-96% cure rate. The modified Epley manoeuvre, a more convenient version and when conducted in the office by a skilled clinician, carries a greater chance of rapid recovery. It may be self-performed at home with a layman assistant.
 Objective: To compare the efficacy of modified Epley’s manoeuvre performed thrice daily with repetitive single sitting, till resolution of symptoms, in posterior canal benign paroxysmal positional vertigo (BPPV) patients.
 Methodology: This prospective comparative clinical study was conducted at Niazi welfare foundation teaching hospital, Sargodha from 1st February 2022 to 31st July 2022. 86 patients with refractory unilateral BPPV were included in the study and divided into two groups. Group A (n=44) patients had modified Epley manoeuvre performed repeatedly at intervals in a single sitting till the resolution of nystagmus. For group B (n=42) patients, Modified Epley manoeuvre was performed once in the clinic, followed by thrice daily manoeuvre done at home till the resolution of symptoms. The time to recovery, the improvement in vertigo (no nystagmus) after a week and recurrence rate among the two groups were evaluated.
 Result: For group A, 61.36% (n=27) patients became symptom-free after 2 attempts, while 100% (n=44) got relief after 5 attempts. For group B the earliest response was seen in 4 patients (9.52%) after 2 days (6 attempts) while 100% improvement (n=42) was seen after 4 days (12 attempts).
 Conclusion: Repeated modified Epley’s manoeuvre in a single sitting promptly reliev vertigo compared to thrice daily manoeuvres.
 Keywords: Benign paroxysmal positional vertigo, Nystagmus, Dix-Hallpike manoeuvre, Particle repositioning manoeuvre, Canalith, Modified Epley manoeuvre.