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CURRENT THERAPIES IN PATIENTS WITH POSTERIOR SEMICIRCULAR CANAL BPPV

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Database electronic search (n=580)

Manual search and supplementary search (n=29)

Identification Screening Eligibility Included FIG. 1.

10 citations as duplicate articles were removed (n=599)

By reading titles and abstracts 480 irrelevant citations were removed (n=119)

1. Performed only for HC-BPPV(n=10) 2. Insufficient for network connections(n=11) 3. Dose not meet the inclusion criteria(n= 51) 4. Irrelevant outcomes(n=6)

78 articles were excluded by reading full articles (n=41)

Articles retrieved for data extraction and network meta-analysis (n=41)

Study screening process.

inconsistencies were resolved through discussion with a third reviewer (Zhang or Chen). Additionally, we assessed the qual ity of evidence that contributed to the network by estimating the main outcomes of confidence in network meta-analysis (CIN eMA) and incorporating six domains (within-study bias, report ing bias, indirectness, imprecision, heterogeneity, and incoherence) (25) of the Grading of Recommendations Assess ment, Development and Evaluation (GRADE) framework (26). All data were processed by R foundation (Vienna, Austria, version 4.0.3, ‘‘rJava,’’ ‘‘xlsxjars,’’ ‘‘rjags,’’ ‘‘gemtc,’’ ‘‘net meta,’’ ‘‘stats,’’ ‘‘meta,’’ and ‘‘ggplot2’’ packages) and Review Manager software (RevMan, Version 5.4.1, The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark, 2020). Included Studies A total of 580 studies were identified in the initial electronic search, and 29 studies were identified by additional manual searching. We excluded 490 irrelevant and duplicate articles after screening titles and abstracts, and the full texts of the remaining 119 potentially eligible articles were further retrieved. According to the inclusion criteria, studies that only referred to HC-BPPV or had insufficient outcome data (e.g., only DHI scores or RESULTS

recurrence rates) for network connections were excluded. Overall, a total of 41 parallel RCTs including 12 types of treatments (11 ‘‘active treatments’’ and one sham maneuver) for PC-BPPV were included for further anal ysis (Fig. 1). Characteristics of the Included Studies As shown in Figure S1, http://links.lww.com/MAO/ B400, a total of 4,036 patients (women: 1,864) suffering from PC-BBPV were randomly assigned to 12 treat ments, including comparisons of otolith repositioning maneuver (ORM) versus a sham maneuver, ORM versus vestibular rehabilitation (VR), ORM versus antivertigo drugs (AVDs), and comparisons among various ORMs. According to the practice guideline for BPPV (17), we classified betahistine, labyrinthine sedative, and cinnar izine, which were used in the included studies (27–29), as AVD in this meta-analysis; VR included the Brandt Daroff exercise, Cawthorne-Cooksey exercises, and home self-treatment (30); and placebo or no treatment was equivalent to the sham maneuver. The Gans repo sitioning maneuver (GRM), a hybrid of the Semont and Epley maneuvers, is a relatively new treatment maneuver (31). Due to the lack of a treatment-related recurrence

Otology & Neurotology, Vol. 43, No. 4, 2022

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