Epley-Type Maneuvers Versus Brandt-Daroff Exercises for Posterior-Canal Benign Paroxysmal Positional Vertigo: A...

Posterior-canal benign paroxysmal positional vertigo is commonly treated with canalith repositioning maneuvers or habituation exercises. Epley-type maneuvers may provide faster symptom and nystagmus resolution than Brandt-Daroff exercises, but comparative effects on recurrence, functional outcomes, and adverse events remain less certain. This systematic review and meta-analysis synthesized direct comparative evidence evaluating Epley-type maneuvers versus Brandt-Daroff exercises in adults with posterior-canal benign paroxysmal positional vertigo. PubMed/MEDLINE, Web of Science, ScienceDirect, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched using terms related to benign paroxysmal positional vertigo, Epley-type or canalith repositioning maneuvers, and Brandt-Daroff or habituation exercises. English full-text comparative studies were included when they enrolled patients with posterior-canal benign paroxysmal positional vertigo and reported extractable clinical outcomes. Binary outcomes were pooled as risk ratios using random-effects models, while continuous outcomes and adverse events were summarized narratively because of heterogeneity in reporting. Thirteen studies involving 911 analyzed participants were included in the qualitative synthesis. Six studies involving 348 participants contributed to the main short-term treatment-success meta-analysis. Epley-type maneuvers improved short-term treatment success compared with Brandt-Daroff exercises (risk ratio 2.10, 95% confidence interval 1.43-3.07; I² = 65.6%). Five studies involving 301 participants contributed recurrence data. Recurrence did not clearly differ between groups (risk ratio 0.91, 95% confidence interval 0.60-1.36; I² = 15.3%). Functional outcomes generally improved after both interventions, but differences in scales, timing, and reporting precluded meaningful pooling. Reported adverse events were generally minor and transient. Epley-type maneuvers are associated with better short-term resolution of posterior-canal benign paroxysmal positional vertigo than Brandt-Daroff exercises, but available evidence does not show a clear recurrence advantage. The certainty of evidence was low for short-term success and recurrence and very low for adverse events, mainly because of risk of bias, heterogeneity, imprecision, and inconsistent reporting.