Epley maneuver versus 360° maneuver for treatment of posterior canal benign paroxysmal positional vertigo in a mechanical rotation chair: a randomized controlled trial.

OBJECTIVE

To compare the treatment efficacy of the Epley maneuver and the 360° maneuver in a cohort diagnosed with posterior benign paroxysmal positional vertigo (BPPV) using a mechanical rotation chair (MRC).

STUDY

DESIGN

Open-label parallel group randomized controlled trial.

SETTING

Tertiary university hospital-based outpatient clinic.

PARTICIPANTS

Adults (n = 102) diagnosed with unilateral posterior BPPV.

INTERVENTIONS: Participants were randomized to treatment with either the Epley- or the 360° maneuver. Follow-up visits were scheduled biweekly until treatment was successful or up to five treatments were given. By use of questionnaires, patient-reported outcome measures were assessed at baseline and after successful treatment. Subjective recurrences were assessed at 3- and 6-month follow-up questionnaires.

MAIN OUTCOME MEASURES: Primary outcome: treatment success after one treatment. Secondary outcomes: number of treatments to obtain treatment success, Dizziness Handicap Inventory (DHI), visual analogue scale (VAS) of vertigo, maneuver tolerability, and subjective recurrence.

RESULTS

Treatment success after one treatment was comparable between the groups (risk difference (RD): -0.12 (95% confidence interval (CI): -0.32, 0.07)). The cumulative probability of treatment success across treatments showed no clear difference between groups (hazard ratio: 0.77, 95% CI: 0.50, 1.21). Both groups showed clinically meaningful improvements in DHI and VAS of vertigo, with no between-group differences. Subjective recurrence rates were also similar.

CONCLUSION

Epley- and 360° maneuvers with an MRC demonstrated similar treatment efficacy across objective and patient-reported outcomes, suggesting flexibility in the maneuver choice. Further research should investigate optimization of treatment protocols and long-term follow-up regarding recurrence patterns.

CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/, identifier NCT05834452.