This is an interesting paper that looks at getting patients to do their own particle repositioning manoeuvre (PRM) after having it done by a clinician (‘Epley’ to you and me although there are some slight differences) once a week for five years! The writing up of the methodology is a bit confusing but I think the control group didn’t do the PRM but were followed up. There’s no real mention of blinding of assessors that might have affected the results.

The reduction in recurrence was impressive in the first and second years: 3.5% study vs 27.2% control and 2% control vs 9% study group respectively. This study provides evidence that patients can self-administer PRM, it is feasible and should reduce recurrence.

Every week for five years seems a lot and I suspect compliance would be an issue. I might try teaching patients the technique and getting them to self-administer if they feel a return of symptoms with re-referral if there is a failure to respond. 

Home particle repositioning maneuver to prevent the recurrence of posterior canal BPPV.
Ismail EI, Morgan AE, Abdeltawwab MM.
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Ravi Thevasagayam

Clinical Lead, Department of ENT, Sheffield Children’s Hospital, Sheffield, S10 2TH, UK.

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