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Published in: European Archives of Oto-Rhino-Laryngology 8/2017

01-08-2017 | Review Article

A safe-repositioning maneuver for the management of benign paroxysmal positional vertigo: Gans vs. Epley maneuver; a randomized comparative clinical trial

Authors: Alia Saberi, Shadman Nemati, Salah Sabnan, Fatemeh Mollahoseini, Ehsan Kazemnejad

Published in: European Archives of Oto-Rhino-Laryngology | Issue 8/2017

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Abstract

Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo. Some repositioning maneuvers have been described for its management. The aim of this study was comparing the therapeutic effect of Epley and Gans maneuvers in BPPV. This randomized clinical trial was performed from September to December 2015. 73 patients with true vertigo diagnosed as BPPV enrolled the study. They randomly assigned in quadripartite blocks to modified Epley maneuver group (E) or Gans maneuver group (G). 1 day and 1 week after intervention, the objective and subjective responses to treatment were assessed. Statistical analysis was performed using the Chi-square test and regression model in the SPSS software version 21. Thirty patients enrolled each group with a mean age of 46.9 ± 13.4 (E group) and 46.7 ± 7.5 year (G group). 23.3 % of E group and 26.7 % of G group were men (p = 0.766). In E and G groups in the first day, subjective outcomes revealed 86.7 and 60 % rate of success (p = 0.02); and 86.7 and 56.7 % of patients exhibited objective improvement, respectively (p = 0.01). After 1 week, the subjective and objective outcomes revealed improvement among 70 % of E group and 46.7 % of G group (p = 0.067). The only complication with significant difference was cervical pain with a higher rate in E group (23.3 vs. 0.0 %, p = 0.005). These results revealed the similar long-term efficacy of Epley and Gans maneuver for the treatment of BPPV. Cervical pain was most frequent complication of Epley maneuver.
Literature
1.
go back to reference Brandt T, Steddin S, Daroff R (1994) Therapy for benign paroxismal positioning vertigo, revisited. Neurology 44(5):796–800CrossRefPubMed Brandt T, Steddin S, Daroff R (1994) Therapy for benign paroxismal positioning vertigo, revisited. Neurology 44(5):796–800CrossRefPubMed
2.
go back to reference Yardley L, Owen N, Nazareth I, Luxon L (1998) Prevalence and presentation of dizziness in a general practice community sample of working age people. Br J Gen Pract 48(429):1131–1135PubMedPubMedCentral Yardley L, Owen N, Nazareth I, Luxon L (1998) Prevalence and presentation of dizziness in a general practice community sample of working age people. Br J Gen Pract 48(429):1131–1135PubMedPubMedCentral
3.
go back to reference Schessel D, Minor L, Meniere Nedzelski J (1998) Disease and other peripheral vestibular disorders. In: Cummings CW (ed) Otolaryngology head and neck surgery, 3rd edn. Mosby Medical Publishers, London, p 2687 Schessel D, Minor L, Meniere Nedzelski J (1998) Disease and other peripheral vestibular disorders. In: Cummings CW (ed) Otolaryngology head and neck surgery, 3rd edn. Mosby Medical Publishers, London, p 2687
4.
go back to reference Cesarani A, Alpini D (1999) Vertigo and dizziness rehabilitation: the MCS method, 1st edn. Springer-Verlag, BerlinCrossRef Cesarani A, Alpini D (1999) Vertigo and dizziness rehabilitation: the MCS method, 1st edn. Springer-Verlag, BerlinCrossRef
5.
go back to reference Bath A, Walsh R, Ranalli P, Tyndel F, Bance M, Mai R et al (2000) Experience from a multidisciplinary dizzy clinic. Am J Otol 21:92–97CrossRefPubMed Bath A, Walsh R, Ranalli P, Tyndel F, Bance M, Mai R et al (2000) Experience from a multidisciplinary dizzy clinic. Am J Otol 21:92–97CrossRefPubMed
6.
go back to reference Gans R (2000) Overview of BPPV: treatment methodologies. Hear Rev. 7:34–38 Gans R (2000) Overview of BPPV: treatment methodologies. Hear Rev. 7:34–38
7.
go back to reference Barany R (1921) Diagnose von Krankheitserscheimungenim Bereiche des Otolithenapparates. Acta Otolaryngol Stockholm 2:434–473CrossRef Barany R (1921) Diagnose von Krankheitserscheimungenim Bereiche des Otolithenapparates. Acta Otolaryngol Stockholm 2:434–473CrossRef
8.
go back to reference Migueis A, Semont A, Garcia CS, Paco J (2005) Up-to-date on the BPPV: semont maneuver for the posterior canal. Rev Laryngol Otol Rhinol (Bord) 126(1):57–63 Migueis A, Semont A, Garcia CS, Paco J (2005) Up-to-date on the BPPV: semont maneuver for the posterior canal. Rev Laryngol Otol Rhinol (Bord) 126(1):57–63
9.
go back to reference Korres S, Balatsouras D, Kaberos A, Economou C, Kandiloros D, Ferekidis E (2002) Occurrence of semicircular canal involvement in benign paroxysmal positional vertigo. Otol Neurotol 23:926–932CrossRefPubMed Korres S, Balatsouras D, Kaberos A, Economou C, Kandiloros D, Ferekidis E (2002) Occurrence of semicircular canal involvement in benign paroxysmal positional vertigo. Otol Neurotol 23:926–932CrossRefPubMed
10.
go back to reference Zucca G, Valli A, Valli P, Mira E (1998) Why do benign paroxysmal positional vertigo episodes recover spontaneously? J Vet Res 8:325–329 Zucca G, Valli A, Valli P, Mira E (1998) Why do benign paroxysmal positional vertigo episodes recover spontaneously? J Vet Res 8:325–329
11.
go back to reference Nuti D, Nati C, Passali D (2000) treatment of benign paroxysmal positional vertigo: no need for postmanoeuver restrictions. Otolaryngol Head Neck Surg 122:440–444PubMed Nuti D, Nati C, Passali D (2000) treatment of benign paroxysmal positional vertigo: no need for postmanoeuver restrictions. Otolaryngol Head Neck Surg 122:440–444PubMed
12.
go back to reference Dispenza F, Stefano AD, Mathur N, Croce A, Gallina S (2011) Benign paroxysmal positional vertigo following whiplash injury: a myth or a reality? Am J Otolaryngol 32(5):376–380CrossRefPubMed Dispenza F, Stefano AD, Mathur N, Croce A, Gallina S (2011) Benign paroxysmal positional vertigo following whiplash injury: a myth or a reality? Am J Otolaryngol 32(5):376–380CrossRefPubMed
13.
go back to reference Froehling D, Silverstein M, Mohr D, Beatty C, Offord K, Ballard D (1991) Benign positional vertigo: incidence and prognosis in a population-based study in Olmsted County, Minnesota. Mayo Clin Proc 66(6):596–601CrossRefPubMed Froehling D, Silverstein M, Mohr D, Beatty C, Offord K, Ballard D (1991) Benign positional vertigo: incidence and prognosis in a population-based study in Olmsted County, Minnesota. Mayo Clin Proc 66(6):596–601CrossRefPubMed
14.
go back to reference Balatsouras D, Ganelis P, Aspris A, Economou N, Moukos A, Koukoutsis G (2012) Benign paroxysmal positional vertigo associated with Meniere’s disease: epidemiological, pathophysiologic, clinical, and therapeutic aspects. Ann Otol Rhinol Laryngol 121(10):682–688CrossRefPubMed Balatsouras D, Ganelis P, Aspris A, Economou N, Moukos A, Koukoutsis G (2012) Benign paroxysmal positional vertigo associated with Meniere’s disease: epidemiological, pathophysiologic, clinical, and therapeutic aspects. Ann Otol Rhinol Laryngol 121(10):682–688CrossRefPubMed
15.
go back to reference Bhattacharyya N, Baugh R, Orvidas L, Barrs D, Bronston L, Cass SS et al (2008) Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 139:S47–S81CrossRefPubMed Bhattacharyya N, Baugh R, Orvidas L, Barrs D, Bronston L, Cass SS et al (2008) Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 139:S47–S81CrossRefPubMed
16.
go back to reference Semont A, Freyss G, Vitte E (1988) Curing the BPPV with a liberatory maneuver. Adv Otorhinolaryngol 42:290–293PubMed Semont A, Freyss G, Vitte E (1988) Curing the BPPV with a liberatory maneuver. Adv Otorhinolaryngol 42:290–293PubMed
17.
go back to reference Epley J (1992) The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 119:399–404CrossRef Epley J (1992) The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 119:399–404CrossRef
18.
go back to reference Herdman S, Tusa R, Zee D, Proctor L, Mttox D (1993) Single treatment approaches to benign paroxysmal positional vertigo. Arch Otolaryngol Head Neck Surg 119:450–454CrossRefPubMed Herdman S, Tusa R, Zee D, Proctor L, Mttox D (1993) Single treatment approaches to benign paroxysmal positional vertigo. Arch Otolaryngol Head Neck Surg 119:450–454CrossRefPubMed
19.
go back to reference Aranda-Moreno C, Jauregui-Renaud K (2000) Epley and Semont maneuvers in the treatment of bening paroximal postural vertigo. Gac Med Mex 136(5):433–439PubMed Aranda-Moreno C, Jauregui-Renaud K (2000) Epley and Semont maneuvers in the treatment of bening paroximal postural vertigo. Gac Med Mex 136(5):433–439PubMed
20.
go back to reference Gans R, Harrington-Gans P (2002) Treatment efficacy of benign paroxysmal positional vertigo (BPPV) with canalith repositioning manoeuver and semont liberatory manoeuver in 376 patients. Semin Hearing 23:129–142CrossRef Gans R, Harrington-Gans P (2002) Treatment efficacy of benign paroxysmal positional vertigo (BPPV) with canalith repositioning manoeuver and semont liberatory manoeuver in 376 patients. Semin Hearing 23:129–142CrossRef
21.
go back to reference Hilton M, Pinder D (2004) The Epley (canalith repositioning) maneuver for benign paroxysmal positional vertigo. Cochrane Database of Systematic Reviews (2):Art. No.: CD003162 Hilton M, Pinder D (2004) The Epley (canalith repositioning) maneuver for benign paroxysmal positional vertigo. Cochrane Database of Systematic Reviews (2):Art. No.: CD003162
22.
go back to reference Nunez R, Cass S, Furman J (2000) Short- and long-term outcomes of canalith repositioning for benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 122:647–652PubMed Nunez R, Cass S, Furman J (2000) Short- and long-term outcomes of canalith repositioning for benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 122:647–652PubMed
23.
go back to reference Roberts R, Gans R, DeBoodt J, Lister J (2005) Treatment of benign paroxysmal positional vertigo: necessity of postmaneuver patient restrictions. J Am Acad Audiol 16:357–366CrossRefPubMed Roberts R, Gans R, DeBoodt J, Lister J (2005) Treatment of benign paroxysmal positional vertigo: necessity of postmaneuver patient restrictions. J Am Acad Audiol 16:357–366CrossRefPubMed
24.
go back to reference Roberts RA, Gans RE, Montaudo RL (2006) Efficacy of a new treatment maneuver for posterior canal benign paroxysmal positional vertigo. J Am AcadAudiol 17:598–604 Roberts RA, Gans RE, Montaudo RL (2006) Efficacy of a new treatment maneuver for posterior canal benign paroxysmal positional vertigo. J Am AcadAudiol 17:598–604
25.
go back to reference Ruckenstein M (2001) Therapeutic efficacy of the Epley canalith repositioning maneuver. Laryngoscope. 111(6):940–945CrossRefPubMed Ruckenstein M (2001) Therapeutic efficacy of the Epley canalith repositioning maneuver. Laryngoscope. 111(6):940–945CrossRefPubMed
26.
go back to reference Sakata E, Ohtsu K, Sakata H (2004) Pitfalls in which otolaryngologists often are caught in the diagnosis and treatment of vertigo. Int Tinnitus J. 10:31–34PubMed Sakata E, Ohtsu K, Sakata H (2004) Pitfalls in which otolaryngologists often are caught in the diagnosis and treatment of vertigo. Int Tinnitus J. 10:31–34PubMed
27.
go back to reference Radtke A, Brevern MV, Tiel-Wilck K, Mainz-Perchalla A, Neuhauser H, Lempert T (2004) Self-treatment of benign paroxysmal positional vertigo Semont maneuver vs. Epley procedure. Neurology 63:150CrossRefPubMed Radtke A, Brevern MV, Tiel-Wilck K, Mainz-Perchalla A, Neuhauser H, Lempert T (2004) Self-treatment of benign paroxysmal positional vertigo Semont maneuver vs. Epley procedure. Neurology 63:150CrossRefPubMed
28.
go back to reference Brevern MV, Seeling T, Radtke A, Tiel-Wilck K, Neuhauser H, Lempert T (2006) Short-term efficacy of Epley’s manoeuvre: a double-blind randomised trial. J Neurol Neurosurg Psichiatry 77(8):980–982CrossRef Brevern MV, Seeling T, Radtke A, Tiel-Wilck K, Neuhauser H, Lempert T (2006) Short-term efficacy of Epley’s manoeuvre: a double-blind randomised trial. J Neurol Neurosurg Psichiatry 77(8):980–982CrossRef
29.
go back to reference Richard W, Bruintjes T, Oostenbrink P, Leeuwen RV (2005) Efficacy of the Epley maneuver for posterior canal BPPV: a long-term, controlled study of 81 patients. Ear Throat Nose J 84(1):22–25 Richard W, Bruintjes T, Oostenbrink P, Leeuwen RV (2005) Efficacy of the Epley maneuver for posterior canal BPPV: a long-term, controlled study of 81 patients. Ear Throat Nose J 84(1):22–25
30.
go back to reference Massoud E, Ireland D (1996) Post-treatment instructions in the nonsurgical management of benign paroxysmal positional vertigo. J Otolaryngol 25:121–125PubMed Massoud E, Ireland D (1996) Post-treatment instructions in the nonsurgical management of benign paroxysmal positional vertigo. J Otolaryngol 25:121–125PubMed
31.
go back to reference Marciano E, Marcelli V (2002) Postural restrictions in labyrintholithiasis. Eur Arch Otorhinolaryngol 259:262–265CrossRefPubMed Marciano E, Marcelli V (2002) Postural restrictions in labyrintholithiasis. Eur Arch Otorhinolaryngol 259:262–265CrossRefPubMed
32.
go back to reference Cohen H, Kimball K (2004) Treatment variations on the Epley maneuver for benign paroxysmal positional vertigo. Am J Otolaryngol 25:33–37CrossRefPubMed Cohen H, Kimball K (2004) Treatment variations on the Epley maneuver for benign paroxysmal positional vertigo. Am J Otolaryngol 25:33–37CrossRefPubMed
33.
go back to reference Mujeeb M, Khan N (2000) Epley’s Maneuver: treatment of choice for benign paroxysmal positional vertigo. J laryngol Otol 114:844–847PubMed Mujeeb M, Khan N (2000) Epley’s Maneuver: treatment of choice for benign paroxysmal positional vertigo. J laryngol Otol 114:844–847PubMed
34.
go back to reference Helminski J, Zee D, Janssen I, Hain T (2010) Effectiveness of particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo: a systematic review. Phys Ther 90(5):1–16CrossRef Helminski J, Zee D, Janssen I, Hain T (2010) Effectiveness of particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo: a systematic review. Phys Ther 90(5):1–16CrossRef
35.
go back to reference Badawy Wanees MA, El-Mawla Ebtessam KG, Chedid Ahmed EF, Mustafa Ahmed HA (2015) Effect of a hybrid maneuver in treating posterior canal benign paroxysmal positional vertigo. J Am Acad Audiol 26(2):138–144CrossRefPubMed Badawy Wanees MA, El-Mawla Ebtessam KG, Chedid Ahmed EF, Mustafa Ahmed HA (2015) Effect of a hybrid maneuver in treating posterior canal benign paroxysmal positional vertigo. J Am Acad Audiol 26(2):138–144CrossRefPubMed
Metadata
Title
A safe-repositioning maneuver for the management of benign paroxysmal positional vertigo: Gans vs. Epley maneuver; a randomized comparative clinical trial
Authors
Alia Saberi
Shadman Nemati
Salah Sabnan
Fatemeh Mollahoseini
Ehsan Kazemnejad
Publication date
01-08-2017
Publisher
Springer Berlin Heidelberg
Published in
European Archives of Oto-Rhino-Laryngology / Issue 8/2017
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI
https://doi.org/10.1007/s00405-016-4235-7

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