Rapi̇d evaluati̇on of the effecti̇veness of the epley re-posi̇i̇ti̇oni̇ng maneuver used i̇n BPPV

Benign paroxysmal positional vertigo (BPPV) is the most common peripherical vestibular disease. BPPV can be described as transient attack of vertigo which is accompanied by characteristic paroxysmal positional nystagmus following rapid head movements. The most common form is posterior canal BPPV. The patients who have complaints of positional vertigo and positive Dix-Hallpike Manoeuvre are treated with canalith repositioning manoeuvre. Through these manoeuvres, otoconias that lap into posterior semicircle are tried to be replaced into the utricle. It is aimed in this study to determine the effective rates of repositioning Epley manoeuvre and to determine if the control time will be reduced or not.125 volunteer individuals who applied to Başkent University, Dr. Turgut Noyan Application and Research Center, Seyhan Hospital Otolaryngology Polyclinic between the years of 2018 and 2019 were included in the study. The patients with the diagnosis of BPPV who had not experienced any BPPV attack during the last three months and who only had one-sided posterior canal BPPV were taken into the study. The control group was named Group I. 63 patients with positive diagnostic Dix-Hallpike were treated with Epley manoeuvre and they were invited to the hospital for the control after a week with position limitation. Sample group was named Group II. 30 minutes after Epley manoeuvre was administered to 62 patients whose Dix-Hallpike test was positive, control Dix-Hallpike test was implemented. The patients who did not display nystagmus in the control test (32.3%) were excluded in the study. Second Epley manoeuvre was re-implemented accompanied with vibration to 42 patients (62.7%) who displayed nystagmus in the control test. Dix-Hallpike test was re-implemented 30 minutes after the second Epley manoeuvre and 11 patients (17.7%) who did not display nystagmus were included in the study as "the ones who had Epley manoeuvre twice". The third Epley manoeuvre was re-implemented accompanied with vibration again to 31 patients (50%) who displayed nystagmus. These patients were included in the study as "the ones who had Epley manoeuvre three times". The patients in the Group II whose treatment had been completed were called to the hospital for the control after a week with position limitation. In all patients who were included in the study, the stimulated positional nystagmus with Dix-Hallpike tests (SPEV; slow-phaseeyevelocity) was noted in "degree" and the duration was recorded in "seconds". The data obtained from the groups before and after the treatment were compared with each other so as to evaluate the activity rates. The mean age of the patients who participated in the study was 55.01±16.14 years (min: 16 -max: 86). The mean age of the patients in the control group (n:63) was 53.82±17.82 years while it was 56.76±13.92 years in the sample group (n:42). It was observed that the distribution of the ages was homogenous in both groups (p>0,05). 68.8 % of the patients who were included in the study were females (n=86). The distributions of gender of the patients in the control and sample groups were close to each other (p>0,05). Dix-hallpike test was found as 79.4 % in the control group at the end of the first week (50 patients) and the test results were found negative at the end of the first week in 71.4 % of the patients (30 patients). There was no statistically significant difference between the groups at the end of the first week in terms of healing rates (p>0.05). The values of the patients in Group I (n:63) (8,69±6,98) were lower than of the patients in Group II (n:42) (9,19±5,76) with regards to outset nystagmus degree. However, no statistically significant difference was found between the groups in terms of nystagmus degree (p>0,05). It was observed in the measurements of nystagmus degrees which were done in the following week that the values of Group I (1,38±3,91) were lower than of Group II (1,48±3,11). However, the difference between them was not statistically significant (p>0,05) Outset nystagmus durations of Group II (30,11±11,23) were higher than Group I (27,14±11,34). However, it was found that the difference between the groups was not statistically significant. On the other hand, it was found in the measurements which were done in the following week that the nystagmus durations of the patients in Group I (3,41±8,12) were higher than of Group II (2,98±5,30) but the difference between them was not considered statistically significant (p>0,05). This particular study showed that the second and third Epley manoeuver which was implemented on the same day did not change the rate of getting negative results in the Dix-Hallpike test which was implemented one week later and it was not statistically significant. However, it helped to obtain lower values in nystagmus duration and degree. This finding is promising that the repetition of Epley manoeuvre on the same session might be more advantageous in terms of reducing the severity of the disease. Keywords: Dizziness, BPPV, Dix-Hallpike, Nystagmus, Epley manoeuver