The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo

Background

Benign paroxysmal positional vertigo (BPPV) is a syndrome characterised by short-lived episodes of vertigo in association with rapid changes in head position. It is a common cause of vertigo presenting to primary care and specialist otolaryngology clinics. Current treatment approaches include rehabilitative exercises and physical manoeuvres including the Epley manoeuvre.

Objectives

To assess the effectiveness of the Epley manoeuvre compared to other treatments available for posterior canal benign paroxysmal positional vertigo, or no treatment.

Search strategy

Our search included the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3 2006), MEDLINE (1952 to 2006) and EMBASE (1974 to 2006). The date of the most recent search was July 2006.

Selection criteria

Randomised trials of adults diagnosed with posterior canal BPPV (including a positive Dix-Hallpike test).

Comparisons sought:

• Epley manoeuvre versus placebo
• Epley manoeuvre versus untreated controls
• Epley manoeuvre versus other active treatment

Outcome measures that were considered included frequency and severity of attacks of vertigo, the proportion of patients improved by each intervention and conversion of a 'positive' Dix-Hallpike test to a 'negative' Dix-Hallpike test.

Data collection and analysis

Both authors independently extracted data and assessed trials for quality.

Main results

Sixteen trials were identified but thirteen studies were excluded because of a high risk of bias, leaving three trials in the review. Trials were mainly excluded because of inadequate concealment during randomisation, or failure to blind outcome assessors. The studies included in the review (Lynn 1995; Froehling 2000; Yimtae 2003) addressed the efficacy of the Epley manoeuvre against a sham manoeuvre or control group by comparing the proportion of subjects in each group who had complete resolution of their symptoms, and who converted from a positive to negative Dix-Hallpike test. Individual and pooled data showed a statistically significant effect in favour of the Epley manoeuvre over controls. There were no serious adverse effects of treatment.

Authors' conclusions

• There is some evidence that the Epley manoeuvre is a safe, effective treatment for posterior canal BPPV, although this is based on the results of only three small randomised controlled trials with relatively short follow up.
• There is no good evidence that the Epley manoeuvre provides a long-term resolution of symptoms.
• There is no good evidence comparing the Epley manoeuvre with other physical, medical or surgical therapy for posterior canal BPPV.