The addition of postural restrictions does not expose the majority of patients to risk of harm, does not pose a major inconvenience, and can be routinely discussed and advised.
The additional intervention of postural restrictions has a number needed to treat (NNT) of 10.
An Epley manoeuvre alone is effective in just under 80% of patients with typical BPPV. However, it important to note that this statistically significant effect only highlights a small improvement in treatment efficacy. There is evidence supporting a statistically significant effect of post-Epley postural restrictions in comparison to the Epley manoeuvre alone. The results should be interpreted carefully and further trials are needed. No serious adverse effects were reported in any of the studies in the review. Compared to the control treatment there were no significant differences in outcomes. One study that also researched post-treatment postural restrictions looked into extra steps in the Epley manoeuvre. Four of the studies reported minor complications such as neck stiffness, horizontal BPPV (a subtype of BPPV which is similar to posterior canal BPPV, but has some distinct differences in terms of the signs and symptoms), dizziness and disequilibrium (the feeling of unsteadiness on ones feet) in some patients.Īdditionally, two studies looked into the application of oscillation/vibration to the mastoid region during the Epley manoeuvre compared to control the intervention produced no difference in outcome between these groups.
Although there was a difference between the groups, adding postural restrictions conferred only a small additional benefit since the Epley manoeuvre was effective alone in just under 80% of patients. There was a statistically significant difference found when these restrictions were compared to a control treatment of the Epley manoeuvre alone. Nine studies looked at post-treatment postural restrictions (using a neck brace/head movement restrictions/instructions to sleep upright) following the Epley manoeuvre. We included 11 studies in this review, with a total of 855 participants. There are also a number of different ways to do the manoeuvre. A range of modifications of the Epley manoeuvre are now used in clinical practice, including applying vibration to the mastoid bone behind the ear during the manoeuvre, having a programme of balance exercises after the manoeuvre has been done, and placing restrictions on a patient's position (for example, not sleeping on the affected ear for a few days). This is a procedure that moves the head and body in four different movements and is designed to remove the particles (causing the underlying problem) from the semicircular canals in the inner ear. The Epley manoeuvre has been shown to improve the symptoms of BPPV. This causes a sensation of ongoing movement that conflicts with other sensory information. BPPV can be caused by particles in the semicircular canal of the inner ear that continue to move when the head has stopped moving. Common causes appear to be head trauma or types of ear infection. The person feels they or their surroundings are moving or rotating. Benign paroxsymal positional vertigo (BPPV) is caused by rapid changes in head position.