Clin Exp Otorhinolaryngol.  2020 Nov;13(4):376-380. 10.21053/ceo.2019.01830.

Therapeutic Efficacy of the Modified Epley Maneuver With a Pillow Under the Shoulders

• Lee HJ
• Jeon EJ
• Lee DH
• Seo JH

• KMID: 2508513
• DOI: http://doi.org/10.21053/ceo.2019.01830

Abstract

Objectives
. Canalolithiasis of the posterior semicircular canal (PC) is the most common reason for benign paroxysmal positional vertigo (BPPV). If a patient is diagnosed with PC-BPPV through the Dix-Hallpike test, the modified Epley maneuver (mEpley) is used as the gold standard treatment. To reduce the discomfort of the standard mEpley, we proposed placing a pillow under the shoulders during this therapeutic maneuver. The purpose of this study was to determine whether the therapeutic efficacy of the mEpley with a pillow under the shoulders (mEpley-PS) was comparable to that of the standard mEpley.
Methods
. A randomized controlled study at three academic referral hospitals was conducted in compliance with the CONSORT statement. Patients who were diagnosed with PC-BPPV through the Dix-Hallpike test were randomly assigned to groups A or B. Patients in groups A and B were treated with the standard mEpley and mEpley-PS, respectively. The resolution of vertigo and nystagmus on the Dix-Hallpike test at a 1-week follow-up after treatment was the main outcome measurement to assess the efficacy of treatment.
Results
. Forty-one patients diagnosed with PC-BPPV were enrolled in this study. Twenty-one patients were assigned to group A and 20 were assigned to group B. The success rate at 1 week after treatment was 85.7% in group A and 80.0% in group B. There was no statistically significant difference between the two groups (P=0.697).
Conclusion
. The therapeutic efficacy of the mEpley-PS was comparable to that of the standard mEpley. The use of the pillow modification may be an excellent alternative if a patient cannot tolerate the head-hanging position, and it is helpful for patients who have anxiety about the head-hanging position. The mEpley-PS can be performed on a bed with or without a headboard. It is both a patient-friendly and a clinician-friendly maneuver.

Keyword

Benign Paroxysmal Positional Vertigo; Semicircular Canals; Epley Maneuver

Figure

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  Fig. 1. Study protocol. Group A received the standard modified Epley maneuver and group B received the modified Epley maneuver with a pillow under the shoulders. The patients were treated with one of the two modified Epley maneuvers at the first visit and then visited the clinic 7 days after treatment for follow-up. PC, posterior semicircular canal; BPPV, benign paroxysmal positional vertigo; DH, Dix-Hallpike.

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  Fig. 2. Difference in the head and neck positions between the standard modified Epley maneuver (mEpley) and the mEpley with a pillow under the shoulders (mEpley-PS).

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  Fig. 3. Modified Epley maneuver with a pillow under the shoulders. (A) Ask the patient to sit upright on an examination table, and rotate the patient’s head at a 45° angle towards the affected side. (B) Quickly push the patient backward: the patient’s upper body and head are reclined backward with the head extended 20°–30° below the pillow, resulting in a natural neck extension with the occiput resting on the surface of the table for 30 seconds. (C) Rotate the patient’s head 90° in the opposite direction, stably supporting it with the table surface. The examiner only guides the direction and angle of the patient’s position for 30 seconds, until the dizziness stops. (D) Rotate the patient in the same direction another 90°, with the unaffected side facing down. The examiner holds the person in this position for 30 seconds, until his or her dizziness stops. (E) Finally, the examiner brings the patient back up to a sitting position.

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