Therapeutic Efficacy of the Modified Epley Maneuver With a Pillow Under the Shoulders

Therapeutic Efficacy of the Modified Epley Maneuver With a Pillow Under the Shoulders

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Objectives Canalolithiasis of the posterior semicircular canal (PC) is the most common reason for benign paroxysmal positional vertigo (BPPV).If a patient is diagnosed with PC-BPPV through the Dix-Hallpike test, the modified Epley maneuver (mEpley) is used as the gold standard treatment.To reduce the discomfort of the standard mEpley, we proposed placing a pillow under the shoulders during this therapeutic maneuver.The purpose of this study was to determine whether the therapeutic efficacy of the mEpley with a pillow under the shoulders (mEpley-PS) was comparable to that of the standard mEpley.Methods A randomized controlled study at three academic referral hospitals Outdoor Swivel Chair w/Cushion (set of 2) was conducted in compliance with the CONSORT statement.

Patients who were diagnosed with PC-BPPV through the Dix-Hallpike test were randomly assigned to groups A or B.Patients in groups A and B were treated with the standard mEpley and mEpley-PS, respectively.The resolution of vertigo and nystagmus on the Dix-Hallpike test at a 1-week follow-up after treatment was the main outcome measurement to assess the efficacy of treatment.Results Forty-one patients diagnosed with PC-BPPV were enrolled in this study.Twenty-one patients were assigned to group A and 20 were assigned to group B.

The success rate at 1 week after treatment was 85.7% in group A and 80.0% in group B.There was no statistically significant difference between the two groups (P=0.697).

Conclusion The therapeutic efficacy of the mEpley-PS was comparable to that of the standard mEpley.The use of the pillow modification may be an excellent alternative if a patient cannot tolerate the head-hanging position, and it is helpful for patients who have anxiety about the head-hanging position.The mEpley-PS can be performed Cutlery Tray on a bed with or without a headboard.It is both a patient-friendly and a clinician-friendly maneuver.