A comparative study of two methods for treatment of benign paroxysmal positional vertigo in the emergency department

D Giardino; M Musazzi; M Perez Akly; M Cherchi; D A Yacovino

doi:10.1016/j.joto.2021.04.002

A comparative study of two methods for treatment of benign paroxysmal positional vertigo in the emergency department

J Otol. 2021 Oct;16(4):231-236. doi: 10.1016/j.joto.2021.04.002. Epub 2021 May 3.

Authors

D Giardino^{1

2}, M Musazzi^{1

2}, M Perez Akly¹, M Cherchi^{3

4}, D A Yacovino^{1

5}

Affiliations

¹ Department of Neurology - Dr Cesar Milstein Hospital, Buenos Aires, Argentina.
² Department of Neurology - Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC), Buenos Aires, Argentina.
³ Department of Neurology - Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
⁴ Chicago Dizziness and Hearing, Chicago, IL, USA.
⁵ Memory and Balance Clinic, Buenos Aires, Argentina.

Abstract

Introduction: Posterior canal benign paroxysmal positional vertigo (PC-BPPV) is considered the most common cause of peripheral vertigo in the emergency department (ED). Although the canalith repositioning maneuver (CRM) is the standard of care, the most effective method to deliver it in the ED has been poorly studied.

Objective: To compare two protocols of the Epley maneuver for the treatment of PC-BPPV.

Patients and methods: We prospectively recruited 101 patients with unilateral PC-BPPV on physical examination, randomizing them to either a single Epley maneuver (EM) (n = 46) or multiple maneuvers (n = 55) on the same visit. Measured outcomes included presence/absence of positional nystagmus, resolution of vertigo, and score on the dizziness handicap inventory (DHI) at follow-up evaluations. The DHI was stratified into mild (≤30) and moderate-severe (>30).

Results: Normalization of the Dix-Hallpike maneuver at day 5 was observed in 38% of the single EM group and 44.4% in the multiple EM group (p = 0.62). The DHI showed reduction from 42.2 (SD 18.4) to 31.9 (SD 23.7) in the single EM group and from 43.7 (SD 22.9) to 33.5 (SD 21.5) in the multiple EM group (p = 0.06). A higher number of patients improved from moderate-severe to mild DHI (p = 0.03) in the single EM group compared to the multi-EM group (p = 0.23).

Conclusion: There was no statistically significant difference between performing a single EM versus multiple EMs for treatment of PC-BPPV in the emergency department. The single EM approach is associated with shorter physical contact between patients and examiner, which is logically safer in a pandemic context.

Keywords: Benign paroxysmal positional vertigo; Emergency department; Epley maneuver; Pandemic.