Figures 1 to 3 evidence Epley maneuver, performed after Dix-Hallpike maneuver 9. Modified Epley maneuver was performed at the diagnosis of BPPV, immediately after diagnostic confirmation using the Dix-Hallpike maneuver. Physical examination of these patients revealed the presence of positioning nystagmus with rotation and upper vestibular component towards the tested ear, at Dix-Hallpike 20 diagnostic maneuver with the use of Frenzel lenses 18.Įxclusion criteria were presence of other concomitant vestibulopathies, cervical spine affections or other reasons that prevented the performance of Dix-Hallpike and/or Epley maneuver, patients that took drugs that could influence the vestibular system.Īll enrolled patients were submitted to otoneurological assessment that included clinical history, ENT physical examination, pure tone and vocal audiometry, immittanciometry and vestibular exam. The subjects presented typical clinical history of this vestibulopathy, comprising severe positional vertigo, with duration below one minute, which could be followed by neurovegetative symptoms, but no auditory symptoms. The patients in this study were recruited in the Ambulatory of the Discipline of Otoneurology, Federal University of Sao Paulo - Escola Paulista de Medicina (UNIFESP - EPM) and signed the Free Informed Consent Term.Īll patients presented diagnostic hypothesis of BPPV, specifically owed to duct lithiasis of posterior semicircular canal. The objective of the present study was to check the importance of head movement restriction in clinical progression of patients with BPPV by duct lithiasis of the posterior semicircular canal when submitted to one single Epley maneuver. The controversy in the literature is about the efficacy of posture restrictions in influencing therapeutic success in patients with BPPV submitted to statoconia repositioning maneuver 18, 19. In the 5 subsequent days, the patient is instructed to avoid sleeping over the affected ear 9, 10, 12, 15, 17. The patient is instructed to avoid head and trunk movement, using a neck collar and sleeping in semi-seated position, with the head inclined at 45o from the horizontal plan for two days. Some authors advocate posture restriction after Epley maneuver to prevent some displacement of statoconia particles towards the semicircular duct. Among them, Epley maneuver, described in 1992, presents excellent therapeutic indexes of clinical improvement 9–12, 15–17. One of the main and most used therapeutic options for BPPV consists of mechanical maneuver for vestibular rehabilitation, which through a sequence of head movements, aim at repositioning the statoconia back to the utriculus 7–17. Some of the movements that caused BPPV clinical manifestations are lying down or standing up from lying down position, adopting lateral position from dorsal decubitus and head hyperextension 5, 6. Vertigo is usually brief - normally it lasts less than one minute, it is episodic and characteristically it is a result of the change in position of head segment. It is prevalent in the elderly and female patients, probably owing to senile degenerative affections and hormonal dysfunction, respectively 1.īPPV is caused by statoconia debris from the utriculus macula that deviate to one or more semicircular ducts, mistakenly stimulating the ampullary crest 2–4. The use of postural restrictions in patients with benign paroxysmal positional vertigo of posterior canal didn't interfere in their clinical evaluation, one week after a unique Epley maneuver.īenign paroxysmal positional vertigo (BPPV) is considered the most common peripheral vestibulopathy, present in approximately 25% of the patients that have dizziness. There was a clinical improvement in 96.0% of the patients from group 1 and in 94.0% from group 2 (p = 0.781). One week after Epley maneuver 82.1% of the patients from group 1 and 73.3% from group 2 didn't present positional nystagmus (p = 0.421). The patients from both groups were reevaluated one week after Epley maneuver, regarding the presence of symptoms and positional nystagmus. The patients from group 1 were informed to restrict their head movements and to use a cervical collar and group 2 patients were not informed about these postmaneuver restrictions. Material and Methodįifty eight patients with benign paroxysmal positional vertigo of posterior canal were randomly divided in two groups following the application of a unique Epley maneuver. To verify the role of postural restrictions in patients with benign paroxysmal positional vertigo of posterior canal, submitted to a single Epley maneuver. The effectiveness of postmaneuver postural restrictions is controversial in patients with benign paroxysmal positional vertigo.
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