Evaluating the Epley Canalolith Repositioning Procedure With and Without a Visual Assistive Device

Moroz, Matthew; Choy, Matthew; Lee, Chang Woo; Hadfield, Hugo; Lasenby, Joan; Stone, Thomas; Bance, Manohar

doi:10.1097/mao.0000000000003017

Cited by 3 publications

(3 citation statements)

References 61 publications

(72 reference statements)

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“…The range of angular deviation studied (Table 2) falls within the range of errors observed during the EM with and without guidance devices (Moroz et al 2021). In fact, a lack of precision was more frequently observed in steps of the maneuver where we found higher susceptibility of failure.…”

Section: Clinical Overviewsupporting

confidence: 69%

Numerical Simulations of the Epley Maneuver With Clinical Implications

Arán-Tapia,

Soto-Varela,

Pérez-Muñuzuri

et al. 2024

Ear &Amp; Hearing

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Objectives: Canalith repositioning procedures to treat benign paroxysmal positional vertigo are often applied following standardized criteria, without considering the possible anatomical singularities of the membranous labyrinth for each individual. As a result, certain patients may become refractory to the treatment due to significant deviations from the ideal membranous labyrinth, that was considered when the maneuvers were designed. This study aims to understand the dynamics of the endolymphatic fluid and otoconia, within the membranous labyrinth geometry, which may contribute to the ineffectiveness of the Epley maneuver. Simultaneously, the study seeks to explore methods to avoid or reduce treatment failure. Design: We conducted a study on the Epley maneuver using numerical simulations based on a three-dimensional medical image reconstruction of the human left membranous labyrinth. A high-quality micro-computed tomography of a human temporal bone specimen was utilized for the image reconstruction, and a mathematical model for the endolymphatic fluid was developed and coupled with a spherical particle model representing otoconia inside the fluid. This allowed us to measure the position and time of each particle throughout all the steps of the maneuver, using equations that describe the physics behind benign paroxysmal positional vertigo. Results: Numerical simulations of the standard Epley maneuver applied to this membranous labyrinth model yielded unsatisfactory results, as otoconia do not reach the frontside of the utricle, which in this study is used as the measure of success. The resting times between subsequent steps indicated that longer intervals are required for smaller otoconia. Using different angles of rotation can prevent otoconia from entering the superior semicircular canal or the posterior ampulla. Steps 3, 4, and 5 exhibited a heightened susceptibility to failure, as otoconia could be accidentally displaced into these regions. Conclusions: We demonstrate that modifying the Epley maneuver based on the numerical results obtained in the membranous labyrinth of the human specimen under study can have a significant effect on the success or failure of the treatment. The use of numerical simulations appears to be a useful tool for future canalith repositioning procedures that aim to personalize the treatment by modifying the rotation planes currently defined as the standard criteria.

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Section: Clinical Overviewsupporting

confidence: 69%

Numerical Simulations of the Epley Maneuver With Clinical Implications

Arán-Tapia,

Soto-Varela,

Pérez-Muñuzuri

et al. 2024

Ear &Amp; Hearing

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“…This is indeed if the canalolithiasis theory holds. The maneuver is simple in theory, but efficacy is dependent on a precise and controlled application, which may not be the case if performed by clinicians not regularly active in vestibular rehabilitation (29). However, consistency in performance and accuracy of the maneuver must improve outcomes.…”

Section: Discussionmentioning

confidence: 99%

Measuring the Angular Accuracy of a Clinician-Performed Epley Maneuver Used to Treat Benign Paroxysmal Positional Vertigo

Murphy

Keogh

2022

Otol Neurotol

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IntroductionParticle repositioning maneuvers have become the criterion standard for managing benign paroxysmal positional vertigo. The Epley canalolith repositioning maneuver is used to treat posterior canal benign paroxysmal positional vertigo and is successful in up to 90% of cases. However, when performed, there are many clinician variabilities, and angles are approximate. It is not known how accurate each angle needs to be for the target canal to be adequately stimulated. The objective of this study was to measure the angular accuracy of clinician-guided Epley maneuvers using a three-axis accelerometer.MethodsTen healthy subjects were recruited; participants had no known audio vestibular pathology. Five right-hand–dominant clinicians performed Epley maneuvers on both ears of two different participants. Twenty maneuvers were carried out in total. Angular movements were recorded using a vestibular feedback electronic device, the SHIMMER accelerometer. Data were recorded and analyzed using the EYESWEB Open Platform.ResultsResults showed that there was angular error at every stage of the clinician-performed Epley maneuver. The most accurate movement was positioning the head to the left of 45 degrees for a left ear maneuver with an average error of 2.94 degrees. The least accurate was when positioning the patient to face the floor at 135 degrees from supine for a right ear maneuver with an average error of 17.6 degrees.ConclusionEven when experienced ENT clinicians perform a standard Epley maneuver, there is a wide range of angular inaccuracy at each stage. Face to floor is particularly inaccurate. However, given that a majority of procedures (90%) work on the first attempt, there must be an acceptable but unknown range of angular inaccuracy. Novel technologies could improve the angular accuracy, potentially give better results, and allow a broad range of individuals to perform a more accurate Epley maneuver.

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“…Moreover, these systems do not provide real-time quantitative feedback on head motions. Recently, another research group developed an Epley maneuver visual assistive device 18 . In this study, the author performed a quantitative analysis of rotation error when performing the Epley maneuver with and without the assistive device.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of an inertial measurement unit sensor-based guiding system for benign paroxysmal positional vertigo treatment: A pilot study

Pastor

Kwon

Joo

et al. 2023

Sci Rep

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Performing an accurate canalith repositioning procedure (CRP) is important for treating benign paroxysmal positional vertigo, because inadequate rotational head angles can result in ineffective otolith mobilization and consequent treatment failure. Specialists-guided Epley maneuver reportedly had mean errors of 13.7°–24.4° while they were significantly larger (40.0°–51.5°) when self-administered. Similar results were obtained for the Barbeque maneuver: mean errors were 9.2°–13.0° by the specialists while they were significantly larger (22.9°–28.6°) when self-administered. Our study aimed to validate the feasibility of an inertial measurement unit sensor-based CRP (IMU-CRP) by analyzing the differences in accuracy in the rotational angles, comparing them with education-based conventional CRP (EDU-CRP). A pilot validation was also performed by analyzing the treatment success rate of IMU-CRP in patients with BPPV. This single-institution prospective, comparative effectiveness study examined 19 participants without active vertigo or prior knowledge of benign paroxysmal positional vertigo and CRP. Participants conducted the Epley and Barbeque roll maneuvers without and with auditory guidance (EDU-CRP vs. IMU-CRP, respectively) twice, and head rotation accuracies were compared. Differences in target angles based on the American Academy of Otolaryngology-Head and Neck Surgery guidelines were considered errors. For BPPV participants, treatment success was assessed based on the presence or absence of nystagmus, vertigo, and dizziness. For all the Epley and Barbeque roll maneuvers steps, the absolute errors were smaller for IMU- than for EDU-CRPs, with significant differences in steps 2–4 and 3–6 of the Epley and Barbeque roll maneuvers, respectively. A learning effect was found in steps 4 and 5 of the Barbeque roll maneuver but not in the Epley maneuver. The treatment success rates after 1 h were 71.4% and 100% for the Epley and Barbeque roll maneuvers, respectively. Real-time feedback on head rotation angles induced more appropriate movements in the Epley and Barbeque roll maneuvers. A guiding device based on head monitoring providing real-time auditory feedback may increase the self-administered CRP success rates in treating benign paroxysmal positional vertigo.

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Evaluating the Epley Canalolith Repositioning Procedure With and Without a Visual Assistive Device

Cited by 3 publications

References 61 publications

Numerical Simulations of the Epley Maneuver With Clinical Implications

Numerical Simulations of the Epley Maneuver With Clinical Implications

Measuring the Angular Accuracy of a Clinician-Performed Epley Maneuver Used to Treat Benign Paroxysmal Positional Vertigo

Feasibility of an inertial measurement unit sensor-based guiding system for benign paroxysmal positional vertigo treatment: A pilot study

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