A systematic review and meta-analysis of new discovered maneuvers for the treatment of posterior canal BPPV.

BACKGROUND

Benign Paroxysmal Positional Vertigo (BPPV) of the posterior canal is commonly treated using the Epley Maneuver (EM). New maneuvers have been developed with potential benefits in ease and self-administration.

OBJECTIVE

To evaluate and compare the effectiveness of the EM with newly developed alternative maneuvers for treating posterior canal BPPV (PC-BPPV).

METHODS

A systematic review and meta-analysis was conducted of randomized controlled trials (RCTs) comparing the EM or placebo with new treatment maneuvers for PC-BPPV. Electronic databases (Scopus, PubMed, ScienceDirect, OVID MEDLINE, PROSPERO, and Cochrane Library) were searched. A pairwise meta-analysis using random-effects models was conducted, and the risk difference (RD) with 95% confidence intervals (CI) was calculated. Doi plots and the Luis Furuya-Kanamori (LFK) index were used to assess publication bias.

RESULTS

Five RCTs involving 422 patients were identified; three studies met criteria for meta-analysis. The pooled immediate treatment effect showed a rate ratio of 1.66 (95% CI: 0.534-5.151), and the follow-up effect showed a rate ratio of 1.64 (95% CI: 0.520-5.152), indicating that the new maneuvers (Half Somersault, Li Maneuver, Rolling over and New Alternate maneuver) demonstrated treatment outcomes comparable to the EM, while the wide confidence intervals reflect the limited number of available studies. The LFK indices were 1.74 (immediate) and 2.16 (follow-up), suggesting minor and major publication bias, respectively.

CONCLUSIONS

Statistical data indicated that newly developed procedures for treating PC-BPPV are potentially advantageous as the EM. These techniques appear simple, and generally well-tolerated, indicating their potential as alternative options to the traditional EM; however, more robust and maneuver-specific studies are needed before firm conclusions can be drawn.

REGISTRATION: PROSPERO ID: CRD42023466129.