Posterior canal benign paroxysmal positional vertigo (PC-BPPV) is a common vestibular cause of dizziness regularly encountered in the outpatient clinic. The condition is often diagnosed with a positive Dix-Hallpike manoeuvre (DHM) – turning the patient’s head 45 degrees to the affected ear in an upright position and rapidly changing to a supine position with neck extended approximately 20 degrees below the horizontal plane. If diagnosis is confirmed, an Epley manoeuvre is often recommended as a canalith repositioning procedure to treat the condition. In most clinical settings these manoeuvres are performed by physicians subjectively estimating the angles. The authors have performed a single-blind randomised control trial comparing standard practice against a more specific and objective head angle measuring (HAM) device. They recruited 32 adult patients with exclusion of participants with other vestibular diagnosis or cervical problems. One patient was lost to follow-up. Their outcome measures were, at week one post-treatment, a negative DHM and assessment of severity of dizziness (using standardised questionnaires). HAM device was developed by the authors and the Department of Computer Science in Chaing Mai University. It consisted of a motion sensor attached to the patient’s head and connected via Bluetooth to a mobile application. All physicians involved in the trial are stated as having more than one year’s experience. Results revealed a significant improvement of each group’s dizziness handicap inventory score. It also found trending improvement of total visual vertigo analog scale (p=0.013 Group 1 measured angles versus p=0.155 Group 2 subjective angles). Negative DHM found in 13 out of 15 patients in Group 1 and 12 out of 16 patients in Group 2 at one week respectively. Significant variations of head angles were observed during the study in Group 2 but all less than 15-degree deviation. In conclusion, it’s useful to see that there is no great difference in outcomes at one week in a small sample for PC-BPPV treatment. However, given the small sample size, it also opens up whether a larger study using this relatively simple technology would be of benefit to see if the outcome remains the same with greater power.
Epley manoeuvre angles
Reviewed by Aaron Ferguson
Comparative Effectiveness of the Exact versus Estimated Angle of Head Position in the Epley Maneuver: A Randomised Controlled Trial.
