Epley Versus Semont-plus Maneuver for Benign Paroxysmal Positional Vertigo

Efficacy of the Epley Versus Semont-plus Maneuver in Patients With Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo: A Randomized Controlled Trial Using Quantitative Video-Nystagmography Measurement

The goal of this clinical trial is to learn which of two head-movement treatments works better for benign paroxysmal positional vertigo (BPPV) of the posterior canal in adults. BPPV is a common cause of short spells of spinning dizziness. It happens when tiny crystals come loose inside the balance organ of the inner ear and drift into one of its canals. Changing head position then brings on a spinning feeling, along with quick jerking movements of the eyes.

The main question it aims to answer is:

* Does one treatment reduce these jerking eye movements more than the other, measured before treatment, 30 minutes after treatment, and 3 days after treatment?

The study will also look at:

• How many participants become free of positional dizziness after treatment
• How many days pass before the dizziness stops
• Whether repeating the treatment at home more times a day shortens recovery
• How often unwanted effects, such as nausea or vomiting, happen with each treatment

Researchers will compare the Semont-plus maneuver to the Epley maneuver, the long-standing standard treatment, to see if it clears the crystals out of the canal faster and more completely.

Participants will:

• Be placed by chance, into the Epley group or the Semont-plus group
• Have the jerking movements of the eyes recorded with video goggles while the doctor moves their head into the position that brings on the dizziness
• Receive their assigned maneuver at the hospital, followed by a second recording about 30 minutes later
• Be taught to carry out the same maneuver on their own at home, as often as they feel able to
• Come back after 3 days for another recording of their eye movements
• Come back after 1 month to talk with the study team about how their dizziness changed over that time
• Keep a short daily diary of their dizziness and of how many times a day they did the maneuver at home

Inclusion Criteria:

• Age 18 years or older
• Posterior semicircular canal benign paroxysmal positional vertigo of the canalolithiasis type, diagnosed according to the Barany Society 2015 diagnostic criteria
• Unilateral involvement of a single semicircular canal

Exclusion Criteria:

• Involvement of more than one semicircular canal
• Any condition making the repositioning maneuver unsafe, including severe cervical spine disease with restricted range of motion or instability, previous cervical spine fracture, severe osteoporosis, unstable cardiovascular disease, or respiratory failure
• Unable to cooperate with the maneuver
• Any ocular or neurologic condition preventing technically adequate videonystagmography recording, such as inability to keep the eyes open, severe ptosis, or interfering spontaneous nystagmus from another cause