xRead - Episodic Vertigo (January 2026)

CURRENT THERAPIES IN PATIENTS WITH POSTERIOR SEMICIRCULAR CANAL BPPV

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allocation concealments, which might lead to the differ ences of EVR treatment effecacies at 1 week and 1 month of follow-ups. Inconsistency ( p < 0.05) between the indirect and direct comparisons of the sham versus the Epley maneu vers was observed at the first week of follow-up. Accord ing to the subgroup analysis based on the symptom durations, the efficacy of Epley was equal to that of the sham for patients with symptom durations more than 1 month, whereas Epley was more effective than the sham for patients with symptom durations of less than 1 month, indicating that the duration of symptoms before treatments might be the reason for such inconsistency (36,37). BPPV patients may resolve spontaneously within the first month (12), thus, treatments for most BPPV patients with a duration of more than 1 month before treatment seem to be ineffective. In addition, inconsistency ( p < 0.05) was also observed between the indirect and direct comparisons of the Epley and Semont maneuvers at 1 week of follow-up. According to the age-based subgroup meta-analysis, the Epley maneuver was more effective than the Semont maneuver for patients over 55 years of age, while the Epley maneuver was equivalent to the Semont maneuver for patients less than 55 years old. The reason for this inconsistency may be that the efficacy of Epley maneuver is often dependent on treatment cooperation between patients and doctors, which is largely affected by patient characteristics (e.g., age, weight, and level of tolerance to vertigo) and the experi ence of the practitioner (38). Second, rapid 180 degrees cartwheel motion from the side-lying position with the head turned to the unaffected ear during the Semont maneuver is more difficult for elderly patients; therefore, the Semont maneuver may be less effective than the Epley maneuver in older patients (39). Limitation of Study Inevitably, there are several limitations in this meta analysis. First, the literature retrieval was restricted to English, which would potentially lead to publication bias. And due to our strict inclusion and exclusion criteria, the percentage of female patients included in our study was less than that of the most epidemiology studies of BPPV (a female predominance of about 2:1). Second, some out comes, such as recurrence and DHI scores, were not synthesized in our meta-analysis, because of the limited number of eligible studies. Third, the Epley maneuver is often combined with several additional therapies which may contribute to the heterogeneity of EVR at different follow-ups. Fourth, due to the lack of direct comparisons of certain treatments and the lack of detailed information on randomization or allocation concealments, the qualities of many treatment comparisons were rated as moderate or low according to the assessments of the GRADE framework.

nystagmus during a Dix–Hallpike test for PC-BPPV patients, whereas at 1 month of follow-up, only the Epley and Semont maneuvers were effective in eliminating nystagmus during a Dix–Hallpike test, of which the duration before treatments and the age of patients poten tially affected the treatment efficacies. PC-BPPV patients may recover spontaneously in approximately one month, but if they receive active treatments, they can recover faster. 1. Von Brevern M, Radtke A, Lezius F, et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry 2007;78:710–5. 2. Mandala M, Califano L, Casani AP, et al. Double-blind randomized trial on the efficacy of the forced prolonged position for treatment of lateral canal benign paroxysmal positional vertigo. Laryngoscope 2020;131:1296–305. 3. Lee S-H, Kim JS. Benign paroxysmal positional vertigo. J Clin Neurol 2010;6:51–63. 4. Dix RHC. The pathology, symptomatology, and diagnosis of certain disorders of the vestibular system. Proc R Soc Med 1952; 54:213–28. 5. Lornes Parnes RG-J. Practice repositioning maneuver for benign paroxysmal positional vertigo. Ann Otol Rhinol Laryngol 1993;102:325–7. 6. Brandt T, Daroff RB. Physical therapy for benign paroxysmal positional vertigo. Arch Otolaryngol 1980;106:484–5. 7. Epley JM, Oregon P. The canalith repositioning procedure For treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 1992;107:309–17. 8. Semont A, Freyss G, Vitte E. Curing the BPPV with a liberatory maneuver. Adv Otorhinolaryngol 1988;42:290–3. 9. Epley JM. New dimensions of benign paroxysmal positional ver tigo. Otolaryngol Head Neck Surg (1979) 1980;88:599–606. 10. Instrum RS, Parnes LS. Benign paroxysmal positional vertigo. Adv Otorhinolaryngol 2019;82:67–9. 11. Blakley BW. A randomized, controlled assessment of the canalith repositioning maneuver. Otolaryngol Head Neck Surg 1994; 110:391–6. 12. Bhattacharyya N, Baugh RF, Orvidas L, et al. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 2008;139 (5 suppl 4):S47–81. 13. Rouse B, Chaimani A, Li T. Network meta-analysis: an introduction for clinicians. Intern Emerg Med 2017;12:103–11. 14. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (Updated March 2011) . Cochrane; 2011. Available from www.handbook.cochrane.org. 15. Hutton B, Salanti G, Caldwell DM, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explan ations. Ann Intern Med 2015;162:777–84. 16. Registers It. International Trial Registers ClinicalTrials.gov. U.S. National Library of Medcine; Dec. 2020. Available at: https:// clinicaltrials.gov/. 17. Pe´rez-Va´zquez P, Franco-Gutie´rrez V, Soto-Varela A, et al. Prac tice guidelines for the Diagnosis and Management of Benign Paroxysmal Positional Vertigo Otoneurology Committee of Span ish Otorhinolaryngology and head and neck surgery consensus document. Acta Otorrinolaringol Esp (Engl Ed) 2018;69:345–66. 18. Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet 2018;391:1357–9. 19. Dias S, Welton NJ, Caldwell DM, et al. Checking consistency in mixed treatment comparison meta-analysis. Stat Med 2010; 29:932–44. REFERENCES

CONCLUSION

At 1 week of follow-up, the EVR, Hybrid, Semont, and Epley maneuvers were effective in eliminating

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

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