xRead - Episodic Vertigo (January 2026)

Systematic Review and Meta-Analysis

Current Therapies in Patients With Posterior Semicircular Canal BPPV, a Systematic Review and Network Meta-analysis §Daibo Li, Danni Cheng, jj Wenjie Yang, §Ting Chen, §Di Zhang, yz Jianjun Ren, and yz Yu Zhao Department of Oto-Rhino-Laryngology; y West China Biomedical Big Data Center, West China Hospital; z Med-X Center for Informatics, Sichuan University; §Department of Otorhinolaryngology, Head and Neck Surgery, Meishan Municipal People’s Hospital, Dongpo Road, Meishan, Sichuan; and jj Center of Biostatistics, Design, Measurement and Evaluation, West China Hospital, Sichuan University, Chengdu, China

SUCRA ¼ 76.1%) and Epley maneuvers (rank second, SUCRA ¼ 65.3%) were effective in eliminating nystagmus during a Dix–Hallpike test. In the pairwise subgroup meta analysis, for patients younger than 55 years of age, the efficacy of the Epley maneuver was comparable to that of the Semont maneuver [rate ratio (RR): 0.99, 95% confidence interval (CI): 0.93–1.05]; for patients with a longer duration before treatment, the effect of the Epley maneuver was equivalent to that of a sham maneuver (RR: 1.07, 95% CI: 0.90–1.29). Conclusion: Among the 12 types of PC-BPPV treatments, the Epley, Semont, EVR, and Hybrid maneuvers were effective in eliminating nystagmus during a Dix–Hallpike test for PC-BPPV at 1 week of follow-up, whereas only the Epley and Semont maneuvers were effective at 1 month of follow-up. The duration before treatments and the age of patients might contribute to the efficacy of treatments. Key Words: Benign paroxysmal positional vertigo — Meta analysis — Treatment. Among three semicircular canals, the most common type is the posterior semicircular canal (PC-BPPV), accounting for 60 to 90% of all BPPVs (3). Accurate diagnosis of the affected canal of BPPV is crucial for treatment. The most popular test for diagnosing PC-BPPV and identifying the University (Z.Y., grant #20ZDYF3010, RJJ, grant #2019HXBH079, #2020SCU12049); The Science and Technology Department of Sichuan Province (Z.Y., grant #2020YFH0090, RJJ, grant#2020YFS0111); The Health Department of Sichuan Province (R.J.J., grant #20PJ030); China Postdoctoral Science Foundation (R.J.J., grant#2020M673250); The Foundation of National Clinical Research Center for Geriatrics (S.H., grant #Z20201013); National Natural Youth Science Foundation of China (R.J.J., grant #82002868). The authors disclose no conflicts of interest. Supplemental digital content is available in the text. DOI: 10.1097/MAO.0000000000003464 Otol Neurotol 43: 421–428, 2022.

Objective: To compare the efficacy of different treatments for posterior semicircular canal benign paroxysmal positional vertigo (PC-BPPV) by using direct and indirect evidence from existing randomized data. Methods: Randomized case-control studies that compared the efficacy of various nonsurgical treatments in PC-BPPV patients at 1 week and 1 month of follow-up were comprehensively screened. Bayesian network meta-analysis was performed to evaluate direct and indirect treatment comparisons. We further conducted subgroup pairwise meta analysis to explore the inconsistency between comparisons of the Epley versus a sham maneuver and the Epley versus the Semont maneuver. Results: A total of 41 parallel, randomized controlled studies were included. The Epley with vestibular rehabilitation (EVR), Epley, Semont and Hybrid maneuvers were effective in eliminating nystagmus during a Dix–Hallpike test at 1 week of follow-up (odds ratios [ORs]: 11.41–23.8, 95% credible interval [CrI]: excluding null), among which EVR showed the best efficacy (the surface area under the cumulative ranking curves [SUCRA] ¼ 77.5%). However, at 1 month of follow-up, only the Semont (rank first, Benign paroxysmal positional vertigo (BPPV) is a world wide inner ear disorder that accounts for 8% of patients with moderate to severe dizziness or vertigo (1), characterized by positional vertigo and nystagmus evoked by changes in head position with respect to gravity (2). Address correspondence and reprint requests to Yu Zhao, M.D., Ph.D., Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, No. 37 Guo Xue Alley, Chengdu, Sichuan, 610041, China; E-mail: yutzhao@VIP.163.com; Jianjun Ren, Ph.D., Department of Oto-Rhino-Laryngology, and West China Biomedical Big Data Center, West China Hospital, West China Medical School, Sichuan University, No. 37 Guo Xue Alley, Chengdu,

Sichuan, 610041, China; E-mail: Jianjun.Ren@scu.edu.cn D.L., D.C., and W.Y. contributed equally to this work.

Funding: This work was supported by West China Hospital, Sichuan University (Z.Y., grant #2019HXFH003, grant#ZYJC21027); Chengdu Science and Technology Bureau (R.J.J., grant #20GJHZ0193); Sichuan

2022, Otology & Neurotology, Inc.

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