Written by Alex Chen
The Epley maneuver increased the likelihood of symptom resolution in benign paroxysmal positional vertigo (BPPV) by 35% compared to control or sham maneuver (OR 4.4, 95% CI 2.6-7.4) for a NNT of 3. This is a safe and easy maneuver to perform that can improve symptoms in your patients.
Why does this matter?
BPPV is a very common cause of vertigo and is a source of a significant distress for many patients. As providers, we prescribe anti-emetics and vestibular suppressants to help patients deal with the vertigo and nausea. However, these medicines are not without side effects, especially in the older patients who may be fall risks and have other co-morbidities. The Epley maneuver (or manoeuvre in British-speak) is safe and can improve symptoms without the side effects seen in other common treatments.
Playas Gon’ Epley – 3LW
This paper looked at a Cochrane review and another recent randomized trial set in 6 EDs. For the Cochrane review, this paper specifically looks at a primary outcome of complete symptom resolution in the intervention group (Epley) compared to the sham maneuver or control group (medication only, no maneuver). Compared to the sham/control groups, Epley maneuver increased likelihood of symptom resolution (56% vs 21%, OR 4.4, ARD 35%) for a NNT of 3. There were no reported serious complications of the treatments. Nausea was the most commonly reported symptom but was not significantly different between groups.
Part of my neuro exam for “dizzy” or vertiginous patients involves a Dix-Hallpike maneuver. This works out because if it is positive, they are already in the correct position to initiate the Epley maneuver. It takes me a few minutes to complete it and if I can improve symptoms in 1 out of 3 patients without any medications, that is a win-win. Also, it seems to get patients out faster, and they tend to feel like you did something. Of course, take caution in patients with any sign of cervical spine issues, concerns for carotid/vertebral artery dissection, and atlantoaxial joint issues. Also, older patients with significant co-morbidities for stroke should still get the appropriate workup for posterior circulation issues.
Epley Maneuver (canalith repositioning) for Benign Positional Vertigo. Acad Emerg Med. 2020 Apr 13. doi: 10.1111/acem.13985. [Epub ahead of print]
Open in Read by QxMD