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ID 118273
Imai, Takao Osaka University|Bell Land General Hospital
Uno, Atsuhiko Osaka General Medical Center
Yamato, Akiyuki Suita Municipal Hospital
Takimoto, Yasumitsu Osaka University|Takimoto Ear, Nose & Throat Clinic
Matsuda, Kazunori Tokushima Prefectural Central Hospital KAKEN Search Researchers
Nishiike, Suetaka Osaka Rosai Hospital
Kawashima, Kayoko Osaka Habikino Medical Center
Iga, Tomoko Osaka University
Ueno, Yuya Osaka University
Ohta, Yumi Osaka University
Sato, Takashi Osaka University
Kamakura, Takefumi Osaka University
Shingai-Higashi, Kayoko Osaka University
Mikami, Shinji Bell Land General Hospital
Kimura, Naomiki Bell Land General Hospital
Nakajima, Takashi Bell Land General Hospital
Tanaka, Akihisa Bell Land General Hospital
Inohara, Hidenori Osaka University
BPPV fatigue
positional nystagmus
posterior canal
Content Type
Journal Article
Background and objectives: Patients with benign paroxysmal positional vertigo of the posterior canal (pc-BPPV) exhibit BPPV fatigue, where the positional nystagmus diminishes with the repeated performance of the Dix–Hallpike test (DHt). BPPV fatigue is thought to be caused by the disintegration of lumps of otoconial debris into smaller parts and can eliminate positional nystagmus within a few minutes [similar to the immediate effect of the Epley maneuver (EM)]. In this study, we aimed to show the non-inferiority of the repeated DHt to the EM for eliminating positional nystagmus after 1 week.
Methods: This multicenter, randomized controlled clinical trial was designed based on the CONSORT 2010 guidelines. Patients who had pc-BPPV were recruited and randomly allocated to Group A or Group B. Patients in Group A were treated using the EM, and patients in Group B were treated using repeated DHt. For both groups, head movements were repeated until the positional nystagmus had been eliminated (a maximum of three repetitions). After 1 week, the patients were examined to determine whether the positional nystagmus was still present. The groups were compared in terms of the percentage of patients whose positional nystagmus had been eliminated, with the non-inferiority margin set at 15%.
Results: Data for a total of 180 patients were analyzed (90 patients per group). Positional nystagmus had been eliminated in 50.0% of the patients in Group A compared with 47.8% in Group B. The upper limit of the 95% confidence interval for the difference was 14.5%, which was lower than the non-inferiority margin.
Discussion: This study showed the non-inferiority of repeated DHt to the EM for eliminating positional nystagmus after 1 week in patients with pc-BPPV and that even the disintegration of otoconial debris alone has a therapeutic effect for pc-BPPV. Disintegrated otoconial debris disappears from the posterior canal because it can be dissolved in the endolymph or returned to the vestibule via activities of daily living.
Classification of evidence: This study provides Class II evidence of the non-inferiority of repeated DHt to the EM for eliminating positional nystagmus after 1 week.
Journal Title
Frontiers in Neurology
Frontiers Media S.A.
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© 2023 Imai, Uno, Yamato, Takimoto, Sato, Matsuda, Takeda, Nishiike, Kawashima, Iga, Ueno, Ohta, Sato, Kamakura, Shingai-Higashi, Mikami, Kimura, Nakajima, Tanaka and Inohara. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY)( The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
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Medical Sciences