Benign positional paroxysmal vertigo (BPPV) is one of the most common causes of dizziness. Its treatment is the repositioning of displaced otoliths by the canalith repositioning manoeuvre (CRM). Post manoeuvre restrictions are commonly given to the patient. Their benefit has been widely debated as many people feel that these are unnecessary. This paper was a randomised controlled trial which sought to determine the efficacy of the epley manoeuvre, a hybrid manoeuvre called the Ganz manoeuvre (GRM) and post manoeuvre restrictions. Forty-five patients were randomised into three treatment groups matched for gender: CRM with post manoeuvre restrictions; GRM alone; and GRM with post manoeuvre restrictions. They had weekly interventions until their symptoms were objectively and subjectively resolved. This took on average two visits in the GRM with post manoeuvre restrictions, 1.7 in the GRM alone and 1.6 in the CRM group. There was no statistical significant difference between the three groups. This may suggest that the GRM is as effective as CRM and that post manoeuvre restrictions add no extra clinical benefit. This is in keeping with other published studies that negate the need for these restrictions. Patients find these difficult on their everyday lives while shopping or driving and this study suggests that they can be advised to return to normal activities. Furthermore, the fact that GRM was as effective as CRM is useful knowledge in the management of the many elderly patients with BPPV with neck problems, or those with a history of trauma, as there is no need for cervical hyperextension. Additionally, whilst the small sample size of this study is questionable, its positive results could be translated to routine ENT and audiology practice.

Effect of a hybrid maneuver in treating posterior canal benign paroxysmal positional vertigo.
Badawy W, El-Mawla E, Chedid A, Mustafa A.
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Cheka R Spencer

MSc, AFHEA, FRCS (ORL-HNS), Royal Free London NHS Foundation Trust, London, UK; Member of the ENT UK Global Health Committee. @ENTUKGlobal

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