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Adverse effect of the Epley maneuver: Anterior canal crisis

Published:October 15, 2022DOI:https://doi.org/10.1016/j.anl.2022.09.008

      Abstract

      Objective

      In the Epley maneuver performed on patients with posterior semicircular canal-benign paroxysmal positional vertigo-canalolithiasis (P-BPPV-Can), an intense downbeat nystagmus and retropulsion rarely appear as soon as they reach the last upright sitting position. It is considered an anterior canal crisis that appears when the otoliths move to the ampullofugal direction in the anterior semicircular canal by changing head and body positions from the healthy-ear-down 135° head position (the third head position) to the upright sitting position (the fourth head position). This study aimed to determine the prevention of this anterior canal crisis.

      Methods

      The anterior canal crisis frequency was compared among the 178 cases that underwent general Epley maneuver (uncorrected Epley maneuver) and the 228 cases that underwent Epley maneuver (corrected Epley maneuver) by preventing head rotation beyond 135° to the healthy ear and the top of the head going down at the third head position.

      Results

      In 6% of patients with P-BPPV-Can who underwent the Epley maneuver, a transient mixed downbeat and torsional nystagmus to the affected ear and retropulsion were observed at the fourth head position (anterior canal crisis). The corrected Epley maneuver significantly reduced the incidence of unpredictable anterior canal crisis (p = 0.017). Additionally, there was no difference in the effect of the Epley maneuver the next day regardless of the anterior canal crisis appearance.

      Conclusion

      Anterior canal crisis is an adverse effect of the Epley maneuver, and its prevention is important for safety. Avoiding head rotation beyond 135° to the healthy ear and/or the top of the head going down at the healthy-ear-down 135° head position is expected to reduce anterior canal crisis.

      Keywords

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      References

        • Epley JM.
        The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo.
        Otolaryngol Head Neck Surg. 1992; 107: 399-404
        • Semont A.
        • Freyss G.
        • Vitte E.
        Curing the BPPV with a liberatory maneuver.
        Adv Oto-Rhino-Laryngol. 1988; 42: 290-293
        • Hilton M.P.
        • Pinder DK.
        The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo.
        Cochrane Database Syst Rev. 2014; 12CD003162
        • Uneri A.
        Falling sensation in patients who undergo the Epley maneuver: a retrospective study.
        Ear Nose Throat J. 2005; 84: 84-85
        • Oh H.J.
        • Kim J.S.
        • Han B.I.
        • Lim JG.
        Predicting a successful treatment in posterior canal benign paroxysmal positional vertigo.
        Neurology. 2007; 68: 1219-1222
        • Maranhão E.T.
        • Whitney S.L.
        • Maranhão-Filho P.
        Tumarkin-like phenomenon as a sign of therapeutic success in benign paroxysmal positional vertigo.
        Arq Neuropsiquiatr. 2018; 76: 534-538
        • Power L.
        • Murray K.
        • Szmulewicz DJ.
        Characteristics of assessment and treatment in benign paroxysmal positional vertigo (BPPV).
        J Vestib Res. 2020; 30: 55-62
        • Shigeno K.
        Observations of nystagmus during the Epley maneuver.
        Equilibrium Res. 2018; 77: 165-176
        • von Brevern M.
        • Bertholon P.
        • Brandt T.
        • Fife T.
        • Imai T.
        • Nuti D.
        • et al.
        Benign paroxysmal positional vertigo: diagnostic criteria.
        J Vestib Res. 2015; 25: 105-117
        • Ikada T.
        • Hashimoto M.
        • Horiike O.
        • Yamashita H.
        Simple eye movement image analysis technique using NIH Image.
        Equilibrium Res. 2002; 61: 90-96
        • Shigeno K.
        • Kitaoka K.
        Erratum to “A new variant of posterior canal-benign paroxysmal positional vertigo-canalolithiasis”.
        Auris Nasus Larynx. 2021; S0385-8146 ([Auris Nasus Larynx (2020) 924-930]): 00040-00047
        • Shigeno K.
        • Ogita H.
        • Funabiki K.
        Benign paroxysmal positional vertigo and head position during sleep.
        J Vestib Res. 2012; 22: 197-203
        • Herdman S.J.
        • Tusa R.J.
        Complications of the canalith repositioning procedure.
        Arch Otolaryngol Head Neck Surg. 1996; 122: 281-286
        • Traboulsi H.
        • Teixido M.
        BPPV Viewer: a downloadable 3D BPPV model for study of otolith disease.
        World J Otorhinolaryngol Head Neck Surg. 2020; 7: 34-39
        • Parnes L.S.
        • Price-Jones R.G.
        Particle repositioning maneuver for benign paroxysmal positional vertigo.
        Ann Otol Rhinol Laryngol. 1993; 102: 325-331
        • Hashimoto S.
        • Naganuma H.
        • Tokumasu K.
        • Itoh A.
        • Okamoto M.
        Three-dimensional reconstruction of the human semicircular canals and measurement of each membranous canal plane defined by Reid's stereotactic coordinates.
        Ann Otol Rhinol Laryngol. 2005; 114: 934-938
        • Kim D.K.
        • Kim D.R.
        • Jeong S.H.
        • Kim G.J.
        • Chang K.H.
        • Jun B.C.
        Analysis of the coplanarity of functional pairs of semicircular canals using three-dimensional images reconstructed from temporal bone magnetic resonance imaging.
        J Laryngol Otol. 2015; 129: 430-434