The Epley manoeuvre for benign paroxysmal positional vertigo (BPPV)

Hilton MP, Pinder DK

Published Online:

September 8, 2010

Benign paroxysmal positional vertigo (BPPV) is caused by a rapid change in head movement. The person feels they or their surroundings are moving or rotating. Common causes are head trauma or ear infection. BPPV can be caused by debris in the semicircular canal of the ear that continues to move after the head has stopped moving. This causes a sensation of ongoing movement that conflicts with other sensory information. The review of trials found that the Epley manoeuvre (four specific movements of the head and body designed to move the debris out the ear canal) is safe and effective in the short term. More research is needed.

Abstract (click to read)

Background:

This is an update of a Cochrane Review first published in The Cochrane Library in Issue 1, 2002 and previously updated in 2004 and 2007.

Benign paroxysmal positional vertigo (BPPV) is a syndrome characterised by short-lived episodes of vertigo in association with rapid changes in head position. It is a common cause of vertigo presenting to primary care and specialist otolaryngology clinics. Current treatment approaches include rehabilitative exercises and physical manoeuvres, including the Epley manoeuvre.

Objectives:

To assess the effectiveness of the Epley manoeuvre compared to other treatments available for posterior canal BPPV, or no treatment.

Search strategy:

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; CENTRAL; PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; mRCT and additional sources for published and unpublished trials. The date of the most recent search was 19 May 2010, following a previous update search in July 2006.

Selection criteria:

Randomised controlled trials of the Epley manoeuvre versus placebo, no treatment or other active treatment for adults diagnosed with posterior canal BPPV (including a positive Dix-Hallpike test). We considered the following outcome measures: frequency and severity of attacks of vertigo, proportion of patients improved by each intervention and conversion of a 'positive' Dix-Hallpike test to a 'negative' Dix-Hallpike test.

Data collection and analysis:

Both authors independently extracted data and assessed trials for risk of bias.

Main results:

We included five trials involving 292 participants in the review. Trials were mainly excluded because of inadequate concealment during randomisation, or failure to blind outcome assessors. The studies included in the review compared the efficacy of the Epley manoeuvre against a sham manoeuvre or control group by comparing the proportion of subjects in each group who had complete resolution of their symptoms, and who converted from a positive to a negative Dix-Hallpike test. Individual and pooled data showed a statistically significant effect in favour of the Epley manoeuvre over controls. There were no serious adverse effects of treatment.

Authors' conclusions:

There is evidence that the Epley manoeuvre is a safe, effective treatment for posterior canal BPPV, based on the results of five mostly small randomised controlled trials with relatively short follow up. There is no good evidence that the Epley manoeuvre provides a long-term resolution of symptoms. There is no good evidence comparing the Epley manoeuvre with other physical, medical or surgical therapy for posterior canal BPPV.

This record should be cited as:

Hilton MP, Pinder DK. The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database of Systematic Reviews 2004, Issue 2. Art. No.: CD003162. DOI: 10.1002/14651858.CD003162.pub2

Assessed as up to date:

May 19, 2010

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Primary Review Group:

Ear, Nose and Throat Disorders Group

Health topics:

Ear, nose, & throat > Ear > Vertigo

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

The Epley manoeuvre for benign paroxysmal positional vertigo (BPPV)

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