Testing the Epley Maneuver for Treating Dizziness in the Emergency Department

Evaluating the Efficacy of Epley Maneuver in the Treatment of Benign Paroxysmal Positional Vertigo in the Emergency Department: A Randomized Controlled Trial.

The goal of this randomized controlled trial is to evaluate the efficacy of the Epley maneuver versus a sham maneuver in treating patients presenting to the emergency department (ED) with BPPV. The main questions that the study aims to answer are:

• What is the mean difference in Dizziness Handicap Inventory (DHI) scores between patients receiving the Epley maneuver and those receiving the sham maneuver 3 days after enrollment?
• What is the immediate response (using a 0-10-point Likert scale) of patients in each arm of the study?
• What is the proportion of patients who, despite agreeing to participate, were unable to complete the full Epley maneuver due to symptom severity?

Researchers will compare the Epley maneuver arm to the sham maneuver arm to see if the Epley maneuver is more effective in reducing BPPV symptoms.

Participants will:

• Undergo either the Epley maneuver or a sham maneuver.
• Complete the Dizziness Handicap Inventory (DHI) questionnaire at baseline and 3 days post-discharge.
• Patients with insufficient improvement in the sham maneuver group will receive a rescue Epley maneuver.
• Have their vertigo severity assessed using a 0-10 point Likert scale at baseline, immediately and post-maneuver.

Inclusion Criteria

• Age: above 18 years old
• Patients presenting to the ED with symptoms of BPPV (single or recurrent episodes of vertigo lasting up to 2 minutes) and a positive DHT (episode of vertigo associated with torsional upbeating nystagmus) indicating a posterior semicircular canal BPPV.
• Patients who are able to understand and provide a signed informed consent to participate in the study Exclusion Criteria
• Severe cervical diseases (e.g., soft tissue disorders, cervical spondylosis, prolapsed intervertebral disks and severe rheumatoid arthritis with cervical instability …)
• Unstable cardiovascular diseases (e.g., hemodynamically unstable, decompensated heart failure, acute myocardial infarction, decompensated valvular diseases, severe arrhythmias …)
• Suspected vertebrobasilar diseases (e.g., cerebellar signs, vision changes, numbness or tingling in the extremities, slurred speech, changes in mental status, confusion …)
• History of high-grade carotid stenosis
• Recent (<24 hours) intake of aminoglycosides, chemotherapeutic agents, cyclophosphamide, loop diuretics, or quinines
• Patients with peripheral causes of vertigo other than BPPV (such as Meniere's disease or vestibular neuritis)
• Patients with central causes of vertigo (vestibular migraine, Arnold Chiari malformation, history of CNS tumor(s), multiple sclerosis)
• Patients with focal deficits on neurological exam
• Patients with an episode of vertigo lasting more than 2 minutes
• Patients with a negative DHT
• Patients with pure horizontal or vertical nystagmus
• Patients with lateral and anterior semicircular canals BPPV
• Participants refusing to undergo Epley maneuver
• Pregnancy beyond the 24th week of gestation