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The test is not positive in patients with anterior and horizontal semicircular canal BPPV, both of which are much less common.Ī positive Dix-Hallpike positional test provokes vertigo and nystagmus when the patient is moved from a sitting position to lying down, with the head tipped 45 degrees below the horizontal, 45 degrees to the side and with the side of the affected ear (and semicircular canal) downward. Posterior canal BPPV is confirmed by a positive Dix-Hallpike positional test (the ‘Hallpike manoeuvre’), with unequivocal features of positional nystagmus. What causes BPPV?Īlthough most cases are unexplained, BPPV is associated with head trauma, vestibular neuritis, vertebrobasilar ischaemia, labyrinthitis, middle ear surgery and periods of prolonged bed rest. Attacks tend to occur in clusters and symptoms may recur, following periods of apparent remission. Symptoms of BPPV usually resolve spontaneously within 1–2 weeks, but may persist for up to several months.
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Canaliths may continue to move after the head stops moving, with stimulation of the vestibular nerve leading to vertigo. lying down in bed, reaching up for high objects, bending over) and may be associated with nausea and vomiting, which can last for up to several hours.īenign paroxysmal positional vertigo is believed to be due to debris (canaliths) in the semicircular canals of the ear. Cervical pain was most frequent complication of Epley maneuver.īenign paroxysmal positional vertigo Complication Efficacy Epley maneuver Gans maneuver Repositioning maneuver.Benign paroxysmal positional vertigo (BPPV)is a syndrome characterised by episodes of vertigo, which last for approximately 1–60 seconds, are related to rapid changes in head position, particularly movements related to gravity and those involving neck extension (eg. These results revealed the similar long-term efficacy of Epley and Gans maneuver for the treatment of BPPV.
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The only complication with significant difference was cervical pain with a higher rate in E group (23.3 vs. After 1 week, the subjective and objective outcomes revealed improvement among 70 % of E group and 46.7 % of G group (p = 0.067). In E and G groups in the first day, subjective outcomes revealed 86.7 and 60 % rate of success (p = 0.02) and 86.7 and 56.7 % of patients exhibited objective improvement, respectively (p = 0.01). 23.3 % of E group and 26.7 % of G group were men (p = 0.766). Thirty patients enrolled each group with a mean age of 46.9 ± 13.4 (E group) and 46.7 ± 7.5 year (G group). Statistical analysis was performed using the Chi-square test and regression model in the SPSS software version 21. 1 day and 1 week after intervention, the objective and subjective responses to treatment were assessed. They randomly assigned in quadripartite blocks to modified Epley maneuver group (E) or Gans maneuver group (G). 73 patients with true vertigo diagnosed as BPPV enrolled the study. This randomized clinical trial was performed from September to December 2015. The aim of this study was comparing the therapeutic effect of Epley and Gans maneuvers in BPPV. Some repositioning maneuvers have been described for its management.
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Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo.