xRead - Episodic Vertigo (January 2026)

424

D. LI ET AL.

Eligible Comparisons included at one week of follow-up

Eligible Comparisons included at one month of follow-up

（ n = 1 ）

（ n = 2 ）

（ n = 8 ）

Sham

（ n = 3 ）

（ n = 12 ）

EO

EO

Sham

（ n = 2 ）

（ n = 6 ）

EAVD

（ n = 12 ）

Semont

EVAD

Semont

（ n = 4 ）

Hybrid

（ n = 2 ）

（ n = 18 ）

（ n = 22 ）

EVR

Epley

Epley

（ n = 3 ）

EVR

AVD

（ n = 3 ）

（ n = 1 ）

VR

QLM

（ n = 1 ）

（ n = 4 ）

EPR

EOC

EOC

VR （ n = 7 ） （ n = 1 ）

（ n = 1 ）

AVD

（ n = 3 ）

A

B

FIG. 2. Network meta-analysis of eligible comparisons. The numbers beside the nodes indicate the number of trials with direct comparisons. The most common treatment included in clinical trials was Epley, which has been compared with head-to-head trials with all other interventions in the network. The size of the circles is proportional to the number of patients in the intervention, and the thickness of the lines is proportional to the number of randomized trials of direct comparison. AVD indicates antivertigo drug; EAVD, Epley with antivertigo drug; EO, Epley with oscillation; EOC, Epley with only one cycle; EPR, Epley with posture restriction; EVR, Epley with vestibular rehabilitation; QLM, quick liberatory maneuver; VR, vestibular rehabilitation.

rate in some potential eligible studies, these studies were unable to be included in this network meta-analysis.

ranking first at the first week of follow-up. Hybrid, Semont, and Epley ranked in second, third, and fourth places at the first week of follow-up, with SUCRA value of 67.9, 65.5, and 61.6%, respectively (Fig. 4A) Efficacy of Treatments at 1 Month Follow-up As shown in Figure 3 and Figure S3, http://link s.lww.com/MAO/B400, only the Epley and Semont maneuvers were effective treatments in the first month of follow-up (ORs: 9.54–12.19, 95% CrI excluding null), while the remaining treatments were as ineffective as the sham because of their wide CrI, including null. The ranking probability of the treatment efficacies at the 1 month follow-up is presented by the SUCRA value in Figure 4B. Semont (SUCRA value: 76.1%) and Epley (SUCRA value: 65.3%) ranked in first and second place, respectively. As expected, the sham group had the worst efficacy at both the first week and first month of follow ups. A total of nine included studies compared the efficacy of the Epley maneuver and the Semont maneuver at the first week of follow-up. The pooled heterogeneity among individual studies was moderate ( I 2 ¼ 61%). According to the age-based subgroup meta-analysis, the Epley maneuver was more effective than the Semont maneuver in patients who were older than 55 years (RR: 1.43, 95% CI: 1.16–1.76, random-effects model), while the efficacy of the Epley maneuver was equivalent to that of the Semont maneuver in younger patients (younger than 55 years, RR: 0.99, 95% CI: 0.93–1.05, I 2 ¼ 0%, Figure S4, http://links.lww.com/MAO/B400). Pairwise Subgroup Meta-analysis of Ages to Explore the Inconsistency at 1 Week of Follow-up

Network Meta-analysis The random effect model fit well at the first week and first month of follow-ups by achieving favorable DIC and I 2 values (141.13 and 4%, 83.93 and 0%, respectively). Figure 2 shows the network of eligible comparisons at the first week and first month of follow-ups. The most common treatment included in clinical trials was Epley (Fig. 2A, n ¼ 22; Fig. 2B, n ¼ 18), which has been compared in head-to-head trials with all other treatments in the network at both of the first week and first month of follow-up. Direct comparisons of the Epley with vestib ular rehabilitation (EVR), VR, and Epley with oscillation (EO) were missing, but all the treatments had indirect comparisons. In the node-split analysis, the direct and indirect comparisons of the Epley versus the Semont ( p ¼ 0.0017) and a sham versus the Epley ( p ¼ 0.0032) were both inconsistent at the first week of follow-up, whereas no significant inconsistency was observed at the first month of follow-up (Figure S2, http://link s.lww.com/MAO/B400). Efficacy of Treatments at 1 Week Follow-up We additionally conducted head-to-head studies sepa rately to assess the differences among treatments and presented by square matrix (shown in Fig. 3 and Figure S3, http://links.lww.com/MAO/B400). The EVR, Epley maneuver, Semont maneuver, and Hybrid maneuver were more effective than other treatments at the first week of follow-up (ORs: 11.41–23.8, 95% CrI excluding null). The EVR maneuver showed the best efficacy (with the largest SUCRA value ¼ 77.5%) of

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

Copyright © 2022 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited.