Abstract

BACKGROUND
Although the Epley maneuver is considered a standard technique to treat benign paroxysmal positional vertigo (BPPV) involving the posterior canal (PC-BPPV), few studies have examined prognostic value of the pattern of the nystagmus elicited during each position of the maneuver. OBJECTIVE: To elucidate characteristics and prognostic value of positioning nystagmus during the second position of the Epley maneuver where a 90-degree head turn following the initial positioning.
METHOD
The Epley maneuver was performed in 126 patients with confirmed PC-BPPV. The characteristics of positioning nystagmus were investigated by Oh HJ using video Frenzel goggles.
RESULT
During the second position, 99 patients developed torsional upbeating nystagmus which was in the same direction (orthotropic nystagmus) as the one during the first position (Hallpike maneuver), while 15 patients showed reversed pattern. In 12 patents, nystagmus was not induced during the second position. All the 99 patients with orthotropic nystagmus had resolution of BPPV after the first or second trial of the Epley maneuver. In contrast, 12 of the 15 patients with reversed nystagmus and 8 of the 12 patients without nystagmus failed to resolve.
CONCLUSION
During the second position of the Epley maneuver, orthotropic pattern of nystagmus predicts a successful repositioning and canalolithiasis while the reversed nystagmus or no nystagmus is suggestive of poor response to repositioning and cupulolithiasis.