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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Article info
Publication history
Published online: October 15, 2022
Accepted:
September 26,
2022
Received in revised form:
August 28,
2022
Received:
June 29,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Japanese Society of Otorhinolaryngology-Head and Neck Surgery, Inc. Published by Elsevier B.V. All rights reserved.
