xRead - Episodic Vertigo (January 2026)

CURRENT THERAPIES IN PATIENTS WITH POSTERIOR SEMICIRCULAR CANAL BPPV

425

0.13 (0.04, 0.35)

1.2 (0.06, 28.15)

0.56 (0.08, 4.07)

2.94 (0.05, 249.7)

0.21 (0.01, 2.98)

1.22 (0.05, 25.54)

0.68 (0.09, 4.61)

1.34 (0.06, 28.5)

1.99 (0.5, 7.9)

Epley

Epely

0.06 (0.01, 0.27)

0.6 (0.02, 19.13)

0.28 (0.03, 2.91)

1.48 (0.02, 154.64)

0.11 (0.01, 1.54)

0.61 (0.02, 18.3)

0.34 (0.04, 2.92)

0.68 (0.03, 15.3)

0.75 (0.26, 2.1)

Semont

Semont

11.41 (4.2, 32.6)

15.1 (4.62, 53.62)

9.44 (0.4, 283.99)

4.38 (0.54, 42.2)

23.24 (0.36, 2378.83)

1.64 (0.12, 24.76)

9.6 (0.38, 255.2)

5.33 (0.72, 42.38)

10.59 (0.46, 269.63)

Sham

Sham

2.36 (0.08, 72.02)

3.13 (0.1, 107.87)

0.21 (0.01, 6.09)

0.46 (0.01, 17.41)

2.44 (0.01, 524.77)

0.17 (0, 10.1)

1 (0.01, 74.96)

0.56 (0.01, 20.17)

1.1 (0.01, 85.94)

EO

EO

1.16 (0.14, 9.19)

1.56 (0.15, 16.03)

0.1 (0.01, 1.01)

0.5 (0.01, 25.49)

5.31 (0.06, 653.31)

0.37 (0.01, 9.51)

2.16 (0.05, 77.96)

1.21 (0.13, 11.31)

2.42 (0.06, 84.22)

EAVD

EAVD

0.07 (0.01, 0.54)

0.78 (0.11, 5.16)

1.04 (0.14, 7.63)

0.33 (0.01, 15.46)

0.67 (0.04, 11.49)

0.07 (0, 9.77)

0.41 (0, 67.86)

0.23 (0, 19.76)

0.45 (0, 76.33)

Hybrid

EVR

0.04 (0, 0.42)

0.49 (0.06, 3.81)

0.64 (0.06, 6.34)

0.21 (0, 11.28)

0.42 (0.02, 7.49)

0.62 (0.04, 10.12)

5.81 (0.09, 352.52)

3.26 (0.13, 78.99)

6.41 (0.12, 356.52)

EVR

VR

2.38 (0.06, 99.36)

3.17 (0.07, 152.84)

0.21 (0, 9.63)

1.03 (0.01, 152.81)

1.98 (0.03, 149.7)

3.07 (0.05, 194.24)

5.08 (0.07, 336.48)

0.56 (0.02, 21.73)

1.11 (0.01, 91.7)

EPR

EOC

4.61 (0.71, 30.6)

6.25 (0.79, 49.33)

0.41 (0.05, 3.16)

1.96 (0.04, 94.21)

3.98 (0.24, 65.81)

5.94 (0.43, 82.4)

9.61 (0.57, 159.46)

1.91 (0.03, 123.99)

1.99 (0.06, 73.13)

VR

AVD

0.98 (0.03, 29.93)

1.3 (0.04, 46.77)

0.09 (0, 2.88)

0.42 (0, 48.47)

0.83 (0.02, 47.05)

1.25 (0.02, 59.51)

2.05 (0.04, 109.36)

0.41 (0, 59.82)

0.21 (0, 10.55)

EOC

QLM

5.47 (0.46, 65.55)

7.36 (0.5, 111.01)

0.48 (0.03, 7.02)

2.34 (0.03, 148.61)

4.7 (0.18, 119.61)

7 (0.31, 168.54)

11.33 (0.45, 300.08)

2.29 (0.03, 197.94)

1.19 (0.05, 27.4)

5.68 (0.08, 385.27)

AVD

at one week of follow-up

at one month of follow-up

comparisons

FIG. 3. Head-to-head comparisons of the efficacy of included treatments. The square matrix presents relative effects between any pair of treatments in this NMA, with ORs and corresponding 95% CrIs displayed in parentheses. Statistically significant results are in bold and underlined. The dark green triangle matrix ( bottom left ) shows the results of 1 week of follow-up; the light green triangle matrix ( top right ) shows the results of 1 month of follow-up. AVD indicates antivertigo drug; CrI, credible interval; 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; OR, odds ratio; QLM, quick liberatory maneuver; VR, vestibular rehabilitation.

Subgroup Meta-analysis of the Duration Before Treatment A total of seven included studies compared the effi cacy of the Epley maneuver and a sham maneuver at the first week of follow-up. The pooled heterogeneity among individual studies was high ( I 2 ¼ 86%). Based on the random-effects model, the Epley maneuver was more effective than the sham maneuver (RR: 1.77, 95% CI: 1.04–2.99). To identify the factor that might contribute to the heterogeneity, subgroup meta-analysis was con ducted according to the duration before treatments (more or less than 1 month). For patients whose duration before treatment was less than 1 month, the Epley maneuver was more effective than the sham maneuver (RR: 4.15, 95% CI: 1.80–9.58), while for patients whose duration before treatment was more than 1 month, the efficacy of the Epley maneuver was equivalent to that of the sham maneuver (RR: 1.07, 95% CI: 0.90–1.29, I 2 ¼ 0%, Figure S5, http://links.lww.com/MAO/B400). Sensitivity analysis showed that omitting any single study sequentially did not alter the overall effects of the remaining studies, indicating that the results were robust (Figures S4 and S5, http://links.lww.com/MAO/B400). Assessment for the Risk of Bias and Study Quality The risk of bias of each included study is summarized in Figure S6, http://links.lww.com/MAO/B400. We

incorporated the GRADE evaluation in Figure S7–8, http://links.lww.com/MAO/B400. The certainty of evi dence about treatment effects at different follow-up times varied. As shown in the GRADE framework, the quality of many comparisons was rated as low or moderate. However, in the first week of follow-up, the Epley, Semont, Hybrid, and sham maneuvers were rated as high, EVR was rated as moderate, while at the first month of follow-up, the EVR was rated as low, Semont and Epley maneuvers were rated as moderate. This is a comprehensive network meta-analysis of the shorter-term and longer-term efficacies of various treat ments for PC-BPPV, which pooled 41 randomized con trolled studies, including 4,036 patients (women: 1,864) who were randomly assigned to the ‘‘active treatments’’ or to a sham maneuver. The influence of age and duration before treatments were further evaluated by subgroup analyses. The EVR, Hybrid, Semont, and Epley maneuvers were effective in eliminating nystagmus during a Dix–Hall pike test at 1 week of follow-up, among which EVR ranked first with the largest SUCRA value. However, only the Semont and Epley maneuvers were effective in eliminating nystagmus during a Dix–Hallpike test for DISCUSSION

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

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