Office management of benign paroxysmal positional vertigo with Epley's maneuver

The underlying cause of benign paroxysmal positional vertigo is free floating endolymph particles (otoconia displaced from the otolithic membrane of the utricle) in the posterior semicircular canal. Particle repositioning techniques are one of the effective method of treatment. The purpose of the study was to determine the effectiveness of Epley's maneuver against expectant treatment and to find out if this treatment should be used more frequently than watchful waiting for the treatment of BPPV.

This study was carried out at outpatient clinic, departments of ENT, Combined Military hospital Rawalpindi and PNS Shifa hospital Karachi over a three years period from Jan, 2002 to Jan, 2005. Based upon history and Dix-hallpike testing 44 patients diagnosed as benign paroxysmal positional vertigo were collected by convenient sampling from these hospital's outpatient departments and divided by non probability convenience into two groups of 22 each. The control group (group A) was given placebo and the test group (group B) received single treatment by Epley's maneuver in the OPD. The results were analyzed at the end of one and two weeks by history taking and Dix-hallpike testing. Computer software SPSS version 10 was used.

At the end of week one 14 (63.63%) patients of group B were symptom free and 2 (9.1%) patients was much better as compared to the control group where only 1 (4.5%) patient reported as symptom free and another 5 (22.7%) reported as much better. At the end of second week out of those treated by Epley's maneuver 16 (72.7%) reported as symptom free and another 2 (9.1%) as much better whereas 4 (18.2%) patients reported no improvement at all. In the control group only 4 (18.2%) patients reported as symptom free, 3 (13.6%) as much better, 6 (27.3%) as better and 9 (40.9%) reported no change in the symptoms. Chi square test was applied and the value of p came out to be 0.001 and 0.002 at week one and week two respectively.

It was concluded that Epley's maneuver is a much better form of management for benign paroxysmal positional vertigo.