[Meta-analysis of the treatment of benign paroxysmal positional vertigo by Epley and Semont maneuvers]

Abstract

Objective: To determine the effectiveness of Epley and Semont maneuvers in treating benign paroxysmal positional vertigo (BPPV).

Design: Systematic search of the medical literature to identify studies that used Epley or Semont maneuvers in randomized controlled trials to treat BPP'V. Studies were examined blind and the results of the studies with a satisfactory methodological quality were pooled.

Subjects: Four studies of adults with a clinical diagnosis of BPPV.

Main outcome measures: Subjective sensation of vertigo 7 and 30 days after treatment, positional objective nystagmus and vertigo evoked by the Dix-Hallpike test (DHT) 7 and 30 days after treatment.

Results: Seventy percent of Epley maneuver-treated adults and 95% of placebo-treated adults reported new episodes of vertigo at 7 days. Moreover, 100% had a positive DHT (odds ratio 0.11; p = 0. 0072). However, 30 days after treatment 59% of treated adults (Epley or Semont) remained asymptomatic and 89% were unresponsive to DHT. Subjective remission of BPPV occurred in 47% of placebo-treated subjects, but only 27% had a negative DHT (odds ratio 0.05 for Epley maneuver-treated evaluated by DHT).

Conclusions: The Epley canalith repositioning procedure or Semont maneuver had a significantly higher efficacy rate in patients with BPPV than placebo procedures, but results must be evaluated at 30 days by DHT. DHT is an easy, low-cost and effective method for assessing the outcome of treatment in patients with BPPV.