Efficacy of Epley’s canalith repositioning procedure according to the number of repetitions in the same session: comparison of three protocols

Background: The canalith repositioning manoeuvre (CRM) described by Epley remains a grade A recommended treatment for Benign Paroxysmal Positional Vertigo (BPPV) of the posterior semicircular canal (PSC). However, significant variability in the efficacy of Epley CRM has been reported. Aims: To compare the treatment efficacy of different combinations of the Epley CRM and Dix-Hallpike retest. Material and methods: Patients with PSC BPPV were divided into one of the following three treatment groups. Manoeuvre group (M): patients underwent a single Epley CRM without subsequent Dix-Hallpike retesting. Manoeuvre-Control group (MC): patients underwent up to three Epley CRM followed by Dix-Hallpike retesting until nystagmus resolution. Manoeuvre-Control-Manoeuvre group (MCM): A similar procedure to that used in the MC group except that, after the negative Dix-Hallpike retest, there was an additional CRM. Results: A more favourable tendency for recovery was observed in the MCM group. There was a positive odds ratio of 1.1 between groups M and MC at the first control, 2.7 between groups M and MCM, and 2.5 between groups MC and MCM. Conclusions and significance: Close repetition of a single Epley CRM after the first effective one would allow a positional retest to be combined with a reduction in the risk of persistent/recurrent BPPV.