Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-28T09:09:11.086Z Has data issue: false hasContentIssue false
  • English
  • Français

Patients with benign paroxysmal positional vertigo and cervical spine problems: is Epley's manoeuvre contraindicated, and is a proposed new manoeuvre effective and safer?

Published online by Cambridge University Press:  23 April 2010

U M Rashad
U M Rashad*
Affiliation:
ENT Department, Assiut University, Egypt
*
Address for correspondence: Dr Usama M Rashad, ENT Department, Faculty of Medicine, Assuit University, Assuit, Egypt. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Benign paroxysmal positional vertigo is one of the commonest peripheral vestibular causes of vertigo. The particle repositioning manoeuvre (Epley's manoeuvre) has become the ‘gold standard’ treatment for this disorder. Benign paroxysmal positional vertigo can affect any age group but is commoner in older patients. Cervical spine problems (e.g. spondylosis and disc prolapse) are commoner in this age group. Epley's manoeuvre necessitates passive neck movements. Such movements may not be wise in patients at risk of cervical spine fracture.

Patients and methods:

This study included 40 patients complaining of vertigo and diagnosed as having benign paroxysmal positional vertigo. A new particle repositioning manoeuvre was designed for these patients, as an alternative to Epley's manoeuvre.

Results:

At one week review, 36 patients (90 per cent) reported total relief from vertigo. Three patients reported a major improvement in their vertigo, and their residual vertigo was relieved by performing the new manoeuvre again after two weeks. Further clinical reviews at one month, three months, six months and one year found that seven patients had suffered minor attacks of typical benign paroxysmal positional vertigo after three months. All seven were relieved of their symptoms after undergoing the new particle repositioning manoeuvre again.

Conclusion:

The proposed new manoeuvre is simple, effective and safe for treating patients with benign paroxysmal positional vertigo and cervical spine problems.

Keywords

Positional VertigoCervical SpinePhysical Therapy
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 11 , November 2010 , pp. 1167 - 1171
Copyright
Copyright © JLO (1984) Limited 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 Lea, P, Kushnir, M, Shpirer, Y, Zomer, Y, Flecher, S. Approach to benign paroxysmal positional vertigo in old age. Isr Med Assoc 2005;7:447–50Google ScholarPubMed
2 Epley, JM. The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 1992;107:399–404CrossRefGoogle ScholarPubMed
3 Von-Brevern, M, Radtke, A, Lezius, F. Epidemiology of benign paroxysmal positional vertigo. A population-based study. J Neurol Neurosurg Psychiatry 2007;78:710–15CrossRefGoogle ScholarPubMed
4 Froehling, DA, Silverstein, MD, Mohr, DN. Benign positional vertigo: incidence and prognosis in a population-based study in Olmsted County, Minnesota. Mayo Clinic Proc 1991;66:596–601CrossRefGoogle Scholar
5 Hamilton, JD, Johnston, RA, Madhok, R, Capell, HA. Factors predictive of subsequent deterioration in rheumatoid cervical myelopathy. Rheumatology 2001;40:811–15CrossRefGoogle ScholarPubMed
6 Sridhar, S, Panda, N. Particle repositioning manoeuvre in benign paroxysmal positional vertigo: is it really safe? J Otolaryngol 2005;34:41–5CrossRefGoogle ScholarPubMed
7 Oghalai, JS. Unrecognized benign paroxysmal positional vertigo in elderly patients. Otolaryngol Head Neck Surg 2000;122:630–4CrossRefGoogle ScholarPubMed
8 Scherer, H. Neck-induced vertigo. Arch Otorhinolaryngol Suppl 1985;2:107–24Google ScholarPubMed
9 Magarey, ME, Rebbeck, T, Coughlan, B, Grimmer, K, Rivett, DA, Refshauge, K. Pre-manipulative testing of the cervical spine review, revision and new clinical guidelines. Man Ther 2004;9:95–108CrossRefGoogle ScholarPubMed
10 Furman, JM, Cass, SP. Benign paroxysmal positional vertigo. N Engl J Med 1999;341:1590–6CrossRefGoogle ScholarPubMed
11 Parnes, LS, Price-Jones, RG. Particle repositioning maneuver for benign paroxysmal positional vertigo. Ann Otorhinolaryngol 1993;102:325–31Google ScholarPubMed
12 Herdman, SJ, Tusa, RJ, Zee, DS, Proctor, LR, Mattox, DE. Single treatment approaches to benign paroxysmal positional vertigo. Arch Otolaryngol Head Neck Surg 1993;119:450–4CrossRefGoogle ScholarPubMed
13 Marciano, E, Marcelli, V. Postural restrictions in labyrintholithiasis. Eur Arch Otorhinolaryngol 2002;259:262–5CrossRefGoogle ScholarPubMed
14 Roberts, RA, Gans, RE, DeBoodt, JL, Lister, JJ. Treatment of benign paroxysmal positional vertigo: necessity of postmaneuver patient restrictions. J Am Acad Audiol 2005;16:357–66Google ScholarPubMed
15 Lopez, EJ, Gonzalez-Sanchez, M, Salinero, J. Meta-analysis of the treatment of benign paroxysmal positional vertigo by Epley and Semont maneuvers [in Spanish]. Acta Otorrinolaringol Esp 1999;50:366–70Google Scholar
16 Fyrmpas, G, Rachovitsas, D, Haidich, AB, Constantinidis, J, Triaridis, S, Vital, V et al. Are postural restrictions after an Epley maneuver unnecessary? First results of a controlled study and review of the literature. Auris Nasus Larynx 2009;6:637–43CrossRefGoogle Scholar
17 Massoud, EAS, Ireland, PJ. Post treatment instructions in the nonsurgical management of benign paroxysmal positional vertigo. J Otolaryngol 1996;25:121–5Google ScholarPubMed