Regarding patients with BPPV, long-term follow-up studies have indicated that vestibular suppressants may not affect symptom resolution moreover, there is evidence that canalith repositioning procedures are superior to these drugs. There is high-quality and compelling evidence that patients diagnosed with posterior canal BPPV should be offered expeditious treatment with canalith repositioning procedures, commonly referred to as the Epley manoeuvre (EM). Horizontal canal BPPV should be considered when horizontal nystagmus is seen rather than upbeat torsional nystagmus in the DH manoeuvre.
The Dix–Hallpike (DH) manoeuvre is considered the gold standard test for the diagnosis of posterior canal BPPV. However, horizontal canal BPPV is probably much more common than previously recognised. The most common form of BPPV is the posterior semicircular canals, which account for 85% of cases.
It’s characterized by repeated episodes of vertigo, which are triggered by rapid changes in head position. The study was registered in protocols.io (PROTOCOL INTEGER ID: 51,464) on July 11, 2021.īenign paroxysmal positional vertigo (BPPV) is a common inner ear disorder. EM for BPPV in a primary-care setting may aid in preventing referrals to higher tertiary care facilities and hospitalisation for follow-up. This study has shown the significance of performing EM for BPPV in primary-care settings. Regardless of primary-care and subspecialty settings, EM for BPPV was effective. The evidence exhibited uncertainty about the effect of EM on negative findings in primary-care settings and all adverse events in subspecialty settings. In the subspeciality setting, EM reduced the subjective symptoms (RR, 2.42 95% CI, 1.64–3.56), resulting in an increase in negative findings (RR, 1.81 95% CI, 1.40–2.34). In primary-care settings, EM reduced the subjective symptoms however, there was no applicable article for all adverse events. Twenty-seven randomised controlled trials were identified. We evaluated the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach. Primary outcomes were the disappearance of subjective symptoms (vertigo), negative findings (Dix–Hallpike test), and all adverse events. A systematic search was conducted in January 2022 across databases, including Cochrane Central Resister of Controlled Trial, MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature, World Health Organization International Clinical Trials Registry Platform, and. A primary-care setting was defined as a practice setting by general practitioners, primary-care doctors, or family doctors. Systematic review and meta-analysis of randomised sham-controlled trials of EM for the treatment of posterior canal BPPV in primary-care and subspecialty settings. We conducted this systematic review and meta-analysis and clarified the efficacy of EM for BPPV, regardless of primary-care and subspecialty settings. Although previous studies have reported general inexperience with the Epley manoeuvre (EM) among general physicians, no report has evaluated the effect of EM on benign paroxysmal positional vertigo (BPPV) in primary care by using point estimates or certainty of evidence.