A Cochrane review [Abstract] 1 included 11 studies with a total of 745 patients.Five studies compared the efficacy of the Epley manoeuvre against a sham manoeuvre, 3 against other particle repositioning manoeuvres (Semont, Brandt-Daroff and Gans) and 3 against a control (no treatment, medication only, postural restriction). The patients were from 18 to 90 years old, with a sex ratio of 1:1.5 male to female.Complete resolution of vertigo occurred significantly more often in the Epley treatment group when compared to a sham manoeuvre or control (OR) 4.42, 95% CI 2.62 to 7.44; 5 studies, n=273); the proportion of patients resolving increased from 21% to 56%. None of the trials comparing Epley vs. other particle repositioning manoeuvres reported vertigo resolution as an outcome.Conversion from a positive to a negative Dix-Hallpike test significantly favoured the Epley treatment group when compared to a sham manoeuvre or control (OR 9.62, 95% CI 6.0 to 15.42; 8 studies, n=507). There was no difference when comparing the Epley with the Semont manoeuvre (2 studies, n=117) or the Epley with the Gans manoeuvre (one study, n=58). In one study a single Epley treatment was more effective than a week of 3 times daily Brandt-Daroff exercises (OR 12.38, 95% CI 4.32 to 35.47; 81 participants).Adverse effects were infrequently reported. There were no serious adverse effects of treatment.
Another Cochrane review [Abstract] 2 included 11 trials with a total of 855 subjects. The patients were adults with posterior canal BPPV diagnosed with a positive Dix-Hallpike test. A total of 9 single-blind studies without sham treatment used post-Epley postural restrictions as their modification of the Epley manoeuvre. All 9 trials included the conversion of a positive to a negative Dix-Hallpike test within 7 days as an outcome measure. Pooled data from them (n=528) identified a significant difference from the addition of postural restrictions in the frequency of Dix-Hallpike conversion when compared to the Epley manoeuvre alone. In the experimental group 88.7% (220 out of 248) patients vs. 78.2% (219 out of 280) in the control group converted from a positive to negative Dix-Hallpike test (RR 1.13, 95% CI 1.05 to 1.22, p=0.002, NNT 10). No serious adverse effects were reported, however 3 studies reported minor complications such as neck stiffness, horizontal BPPV, dizziness and disequilibrium in some patients.There was no evidence of benefit of mastoid oscillation applied during the Epley manoeuvre, or of additional steps in the Epley manoeuvre.
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