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Running head: EPLEY MANEUVER IN VERTIGO
Epley Maneuver in Vertigo
Chris Van Horssen
University of Mary
Summer 2016
EPLEY MANEUVER IN VERTIGO
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Clinical Scenario: A 65 year old male patient presents to the clinic complaining of dizziness to
the point of nausea. The patient states that his symptoms have not been relieved by lying down or
from taking medications to settle his stomach. The patient is diagnosed with benign paroxysmal
positional vertigo (BPPV) and the provider elects to perform the Epley Maneuver to help resolve
the patients symptoms.
PICO Question: Does the Epley maneuver effectively relieve the symptoms of vertigo in a
patient with BPPV when compared to other nonpharmacological interventions that are used to
treat vertigo?
Summary and Appraisal of Key Evidence:
1. Anagnostou, Stamboulis and Kararizou (2014) compared the efficacy of the Epley mmaneuver
and the Semont maneuver in the treatment of BPPV in a well written and easy to understand
presentation. 102 patients with BPPV were divided into 2 equal groups of 51 and one group was
assigned to have the Epley maneuver done to relieve their BPPV and the other group was
assigned the Semont maneuver. The Epley maneuver was successful in 39 of the 51 patients
whereas the Semont maneuver successfully resolved the symptoms of 34 out of 51 patients
(Auagnostou et al,. 2013). The results of the study indicate that the Epley maneuver is an
effective therapy to implement in order to treat BPPV.
Strengths and opportunities of this study were that the Epley maneuver is an effective option to
use when treating BPPV and that it is just as effective as other nonpharmacological methods. The
selection bias was also eliminated by treating only every other patient with the Epley’s maneuver
and the patient between every other patient with the Semont maneuver. A major weakness of this
study was that the patients were reevaluated only 2-5 hours after the repositioning was done as
the study admittedly confesses is not long enough to rule out any debris that may have remained
in dispersion or that could potentially reenter the canal and cause vertigo again. Threats to the
study include the fact that there was no follow up after the reevaluation to determine if the BPPV
ever redeveloped.
2. Bruintjes, Companjen, Zaag-Loonen and Benthem (2014) conducted a randomized, double
blind controlled trial to evaluate the long term efficacy of the Epley maneuver in treating BPPV.
44 patients with BPPV for atleast a month were randomly divided into two groups of 22 and
were treated with either the Epley maneuver or a sham maneuver. The Epley maneuver resulted
in 20/22 patients successfully preventing a reoccurrence of BPPV for 12 months whereas the
sham group resulted in 10/22 patients being BPPV free after 12 months. The study concludes
that the Epley maneuver is effective in the long term prevention of BPPV.
The strengths and opportunities of this study are the thorough follow up that occurred 12 months
after the maneuver was performed and the study was done as a double blind randomized
controlled trial. A weakness of the study includes that during the follow up period, 6 patients
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were lost, 5 from the sham group and 1 from the Epley group. Because 5 sham group patients
were lost, there is potential that the results of the sham group are inaccurate. Threats to the study
include that the study was conducted on a rather small population sample and may not reflect the
same results if it were to be repeated with a larger sample size.
Clinical Bottom Line:
Based on these two studies, patients who had their BPPV treated with the Epley maneuver show
that the treatment is effective immediately and in the long term management of BPPV. The
strengths of these studies include both studies show significant statistical support of the Epley
maneuver being an effective method of treating BPPV, randomization and limited bias.
Weakness of the studies includes limited participant numbers and small scale testing. In
conclusion, the Epley maneuver can be used to effectively manage BPPV.
References
Anagnostou, E., Stamboulis, E., & Kararizou, E. (2014). Canal conversion after repositioning
procedures: comparison of Semont and Epley maneuver. Journal Of Neurology, 261(5),
866-869. doi:10.1007/s00415-014-7290-2
Bruintjes, T., Companjen, J., Zaag-Loonen, H., & Benthem, P. (2014). A randomised shamcontrolled trial to assess the long-term effect of the Epley manoeuvre for treatment of
posterior canal benign paroxysmal positional vertigo. Clinical Otolaryngology, 39(1), 3944. doi:10.1111/coa.12217