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Benign paroxysmal positional vertigo (BPPV) is a peripheral vestibular disorder that can negatively affect quality of life and daily functioning and increase the risk of falls. BPPV is caused by dislodged otolith particles that become trapped in any of the 3 inner ear semicircular canals (anterior, posterior, or horizontal), but most commonly affects the posterior canal. Due to the posterior canal’s anatomical orientation with vertical alignment and curvature, particles in this canal tend to settle in the lowest portion and are less likely to exit with natural head movements compared with the other canals. When the head moves in the plane of the involved canal, these tiny calcium particles move in response to gravitational forces, generating fluid motion within the inner ear that displaces the cupula, the vestibular system’s main sensory structure. This temporary displacement of the cupula alters vestibular signaling, which causes involuntary eye deviation resulting in the characteristic transient nystagmus and dizziness typically described as vertigo.
Although previous studies have reported general inexperience with the Epley manoeuvre (EM) among general physicians, no report has evaluated the effect of EM on benign paroxysmal positional vertigo (BPPV) in primary care by using point estimates or certainty of evidence. We conducted this systematic review and meta-analysis and clarified the efficacy of EM for BPPV, regardless of primary-care and subspecialty settings.
• Assess patients with vertigo for focal neurologic signs and symptoms, sustained substantial headache or neck pain, inability to stand and spontaneous vertical nystagmus.
• Perform the Dix–Hallpike test only for patients with episodes of vertigo less than 2 minutes and no nystagmus at rest.
• Perform the head impulse, nystagmus and test of skew (HINTS) plus (plus refers to a test of recent hearing loss) examination only for patients with hours or days of constant, ongoing vertigo and nystagmus at rest.
• Assess patients with vertigo for focal neurologic signs and symptoms, sustained substantial headache or neck pain, inability to stand and spontaneous vertical nystagmus.
• Perform the Dix–Hallpike test only for patients with episodes of vertigo less than 2 minutes and no nystagmus at rest.
• Perform the head impulse, nystagmus and test of skew (HINTS) plus (plus refers to a test of recent hearing loss) examination only for patients with hours or days of constant, ongoing vertigo and nystagmus at rest
