Short-term efficacy of Epley's manoeuver for benign paroxysmal positional vertigo: a randomised double-blind placebo-controlled trial

Introduction: Benign paroxysmal positional vertigo of the posterior canal (PC-BPPV) can be effectively treated with Epley's maneuver (EM). However, the magnitude of its effect has been questioned as PC-BPPV may resolve spontaneously. So far, none of the many trials on the efficacy of EM has measured short-term efficacy as required for evaluating treatment of a spontaneously resolving disorder.

Methods: Sixty seven patients with acute unilateral BPPV of the posterior canal confirmed by Dix-Hallpike testing were randomly assigned to treatment with Epley's maneuver (n=36) or a sham procedure consisting of an EM for the healthy side (n=31). In the verum-group, Dix-Hallpike testing and EM was repeated until no more nystagmus and vertigo could be elicited. Patients in the EM-group received up to three maneuvers while patients in the placebo-group received a corresponding number of placebo-maneuvers. On the next day, outcome was assessed by a blinded investigator. Successful treatment was measured by the absence of both positional nystagmus and vertigo. Subsequently, all patients with a still positive Dix-Hallpike-test were treated with EM. Subjective outcome was again assessed by means of a telephone interview one day thereafter.

Results: Treatment of PC-BPPV with the EM was more effective than the sham procedure: after one day, 28 of 35 patients (80%) in the EM-group had neither vertigo nor nystagmus on positional testing compared to three of 31 patients (10%) in the placebo-group (p<0.001). In the EM-group 43% of successfully treated patients had a single EM, whereas 57% needed more than one EM.

Conclusions: This double-blind, placebo-controlled trial on the short-term outcome of EM shows that EM is highly effective in the treatment of PC-BPPV. In about half of the patients repeated EMs during one sessions are required for resolution.