Benign Paroxysmal Positional Vertigo (BPPV)
Conditions
Keywords
Epley, vertigo, bening paroxysmal positional vertigo
Brief summary
The goal of this randomized controlled trial is to evaluate the efficacy of the Epley maneuver versus a sham maneuver in treating patients presenting to the emergency department (ED) with BPPV. The main questions that the study aims to answer are: * What is the mean difference in Dizziness Handicap Inventory (DHI) scores between patients receiving the Epley maneuver and those receiving the sham maneuver 3 days after enrollment? * What is the immediate response (using a 0-10-point Likert scale) of patients in each arm of the study? * What is the proportion of patients who, despite agreeing to participate, were unable to complete the full Epley maneuver due to symptom severity? Researchers will compare the Epley maneuver arm to the sham maneuver arm to see if the Epley maneuver is more effective in reducing BPPV symptoms. Participants will: * Undergo either the Epley maneuver or a sham maneuver. * Complete the Dizziness Handicap Inventory (DHI) questionnaire at baseline and 3 days post-discharge. * Patients with insufficient improvement in the sham maneuver group will receive a rescue Epley maneuver. * Have their vertigo severity assessed using a 0-10 point Likert scale at baseline, immediately and post-maneuver.
Interventions
PROCEDUREEpley Maneuver
The patient's head is turned 45 degrees towards the side that caused the most nystagmus or reproduced their initial symptoms. The patient is then laid down with their head hanging over the edge of the bed. After that, the head will be rotated 90 degrees in the opposite direction, with the head remaining in a dependent position. The patient is then asked to roll onto their side with their head facing downward. They are then brought back to a sitting position and the head is moved forward 45 degrees. Each position is held until the vertigo and/or nystagmus subsides or for at least 30 seconds
PROCEDURESham maneuver
This control maneuver will involve coordinated movements of the hands and legs, while excluding any head movement. Patients will be at first in a sitting position with both feet on the ground and both hands placed on the thighs and then they will be asked to lift both hands off the thighs, keeping the arms extended. They will then be asked to return to their initial upright sitting position. Patients will then raise their right foot off the ground while keeping the left one planted on the ground. It will be an alternating movement between lifting the right and left feet while maintaining a smooth and well- controlled rhythm for 90 seconds.
Sponsors
American University of Beirut Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Caregiver)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age: above 18 years old * Patients presenting to the ED with symptoms of BPPV (single or recurrent episodes of vertigo lasting up to 2 minutes) and a positive DHT (episode of vertigo associated with torsional upbeating nystagmus) indicating a posterior semicircular canal BPPV. * Patients who are able to understand and provide a signed informed consent to participate in the study
Exclusion criteria
* Severe cervical diseases (e.g., soft tissue disorders, cervical spondylosis, prolapsed intervertebral disks and severe rheumatoid arthritis with cervical instability …) * Unstable cardiovascular diseases (e.g., hemodynamically unstable, decompensated heart failure, acute myocardial infarction, decompensated valvular diseases, severe arrhythmias …) * Suspected vertebrobasilar diseases (e.g., cerebellar signs, vision changes, numbness or tingling in the extremities, slurred speech, changes in mental status, confusion …) * History of high-grade carotid stenosis * Recent (\<24 hours) intake of aminoglycosides, chemotherapeutic agents, cyclophosphamide, loop diuretics, or quinines * Patients with peripheral causes of vertigo other than BPPV (such as Meniere's disease or vestibular neuritis) * Patients with central causes of vertigo (vestibular migraine, Arnold Chiari malformation, history of CNS tumor(s), multiple sclerosis) * Patients with focal deficits on neurological exam * Patients with an episode of vertigo lasting more than 2 minutes * Patients with a negative DHT * Patients with pure horizontal or vertical nystagmus * Patients with lateral and anterior semicircular canals BPPV * Participants refusing to undergo Epley maneuver * Pregnancy beyond the 24th week of gestation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Efficacy of Epley | 3 days | The study will compare the average Dizziness Handicap Inventory score change from baseline to day 3 between the Epley maneuver group and the sham maneuver group. The DHI is a 25-item self-administered questionnaire designed to assess the effects of dizziness on various aspects of life, including functional, emotional, and physical domains. Scores range from 0, indicating no disability, to 100, representing severe disability. This scale enables patients to indicate how much dizziness interferes with their daily activities. A higher score reflects a greater perceived handicap caused by dizziness. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Immediate response of patients | 15-30 minutes after intervention | The severity of vertigo will be evaluated using both a 0 to 10-point Likert scale before and after applying the Epley/Sham maneuver. |
| Rate of bounce-back to the ED | 3 days | Calculate the proportion of patients in each arm of the study who return to the ED. |
| Proportion of patients unable to undergo the full Epley maneuver | 15 minutes | The percentage of patients who agreed to participate but could not complete the Epley maneuver due to the severity of their symptoms. |
Countries
Lebanon
Contacts
CONTACTEveline Hitti, MD
Outcome results
None listed