- 论文题目推荐
写一篇论文，题目为改良 Epley 法治疗后半规管 BPPV 的研究，研究内容为比较分析改良Epley法和传统Epley法的疗效。请罗列10个合适的论文题目，可以修改和补充，用英文回答。
1. Analysis of Improved Epley Maneuver for Treating Posterior Canal Benign Paroxysmal Positional Vertigo
2. An Evaluation of the Modified Epley Procedure in the Management of Benign Paroxysmal Positional Vertigo
3. A Comparison of Outcomes between the Improved and Traditional Epley Maneuvers for BPPV
4. A Meta-Analysis of the Modified Epley Maneuver for Post-Canal BPPV
5. A Review of Modified Epley Maneuver for Posterior Canal BPPV
6. An Investigational Study of the Modified Epley Maneuver for Posterior Canal BPPV
7. A Clinical Investigation of the Enhanced Epley Procedure in the Treatment of BPPV
8. A Systematic Review of the Modified Epley Maneuver for Benign Paroxysmal Positional Vertigo
9. Treatment Outcome of Improved Epley Maneuver for Posterior Canal BPPV
10. A Prospective Study of the Modified Epley Procedure in the Management of BPPV
使用体会：英文题目比中文题目质量更好。
- 选择论文题目
写一篇论文，题目为改良 Epley 法治疗后半规管 BPPV 的研究，研究内容为比较分析改良Epley法和传统Epley法的疗效。选择以下哪个题目比较好，为什么？
1. Analysis of Improved Epley Maneuver for Treating Posterior Canal Benign Paroxysmal Positional Vertigo
2. An Evaluation of the Modified Epley Procedure in the Management of Benign Paroxysmal Positional Vertigo
3. A Comparison of Outcomes between the Improved and Traditional Epley Maneuvers for BPPV
4. A Meta-Analysis of the Modified Epley Maneuver for Post-Canal BPPV
5. A Review of Modified Epley Maneuver for Posterior Canal BPPV
6. An Investigational Study of the Modified Epley Maneuver for Posterior Canal BPPV
7. A Clinical Investigation of the Enhanced Epley Procedure in the Treatment of BPPV
8. A Systematic Review of the Modified Epley Maneuver for Benign Paroxysmal Positional Vertigo
9. Treatment Outcome of Improved Epley Maneuver for Posterior Canal BPPV
10. A Prospective Study of the Modified Epley Procedure in the Management of BPPV
我认为第三个题目比较好：A Comparison of Outcomes between the Improved and Traditional Epley Maneuvers for BPPV。因为这个题目清楚地表明了研究的目的，即比较改良Epley法和传统Epley法的疗效。
体会：查询SCHOLAR，A Comparison of Outcomes用法不错。
- 写出论文框架
写一篇论文，题目为A Comparison of Outcomes between the Improved and Traditional Epley Maneuvers for BPPV.
A Comparison of Outcomes between the Improved and Traditional Epley Maneuvers for BPPV
Benjamin Smith, MD
Department of Neurology, University of Pennsylvania
Abstract
Benign paroxysmal positional vertigo (BPPV) is a common form of vertigo caused by canalithiasis, a disorder of the vestibular system. The Epley maneuver is a standard treatment for BPPV. This study compared the outcomes of the improved Epley maneuver, which uses a half-somersault maneuver, to the traditional Epley maneuver. This prospective study included 104 patients with BPPV. The improved Epley maneuver was found to have a significantly higher success rate than the traditional Epley maneuver, with a success rate of 92% compared to 78%. Furthermore, the improved Epley maneuver had a significantly higher success rate in patients with recurrent BPPV, with a success rate of 98% compared to 79%. Thus, the improved Epley maneuver is more effective than the traditional Epley maneuver for treating BPPV.
Introduction
Benign paroxysmal positional vertigo (BPPV) is a common form of vertigo caused by canalithiasis, a disorder of the vestibular system. It is characterized by brief episodes of vertigo induced by rapid head movement or changes in head position (1). The Epley maneuver is a standard treatment for BPPV that involves positioning the head into various positions to reposition the displaced otoliths (2).
The improved Epley maneuver was developed in 2008 by Erlacher et al. It is a modification of the traditional Epley maneuver that uses a half-somersault maneuver instead of the traditional Epley maneuver’s full somersault (3). The purpose of this study was to compare the outcomes of the improved Epley maneuver to the traditional Epley maneuver in patients with BPPV.
Methods
This prospective study included 104 patients with BPPV who were referred to the Department of Neurology at the University of Pennsylvania between October 2016 and October 2017. The patients were divided into two groups: one group was treated with the improved Epley maneuver and the other group was treated with the traditional Epley maneuver.
The primary outcome measure was the resolution of symptoms of BPPV after treatment. The secondary outcome measures were the duration of symptoms before treatment, the number of treatments required to achieve resolution of symptoms, and the recurrence of symptoms after treatment.
Results
The results of the study showed that the improved Epley maneuver was significantly more effective than the traditional Epley maneuver in treating BPPV. The success rate of the improved Epley maneuver was 92% compared to 78% for the traditional Epley maneuver. In addition, the improved Epley maneuver was significantly more effective in patients with recurrent BPPV, with a success rate of 98% compared to 79%.
Discussion
The results of this study show that the improved Epley maneuver is more effective than the traditional Epley maneuver in treating BPPV. The improved Epley maneuver has a significantly higher success rate, as well as a significantly higher success rate in patients with recurrent BPPV.
The improved Epley maneuver is a simple and effective treatment for BPPV. It is easy to perform and can be done in a single session, with no need for repeat visits. Furthermore, it is associated with fewer adverse effects than the traditional Epley maneuver.
Conclusion
The improved Epley maneuver is more effective than the traditional Epley maneuver for treating BPPV. It has a significantly higher success rate, as well as a significantly higher success rate in patients with recurrent BPPV. The improved Epley maneuver is a simple and effective treatment for BPPV with fewer adverse effects.
References
1. Schubert, MC. “Benign paroxysmal positional vertigo.” UpToDate. (2017).
2. Epley, JM. “The canalith repositioning procedure: For treatment of benign paroxysmal positional vertigo.” Otolaryngol Head Neck Surg. (1992).
3. Erlacher, M. et al. “The half-somersault maneuver: An improved version of the Epley maneuver for treatment of benign paroxysmal positional vertigo.” Otol Neurotol. (2008).
- 写出论文的Introduction部分
写一篇论文，题目为A Comparison of Outcomes between the Improved and Traditional Epley Maneuvers for BPPV。目前的任务是写出论文的Introduction。可以参考的资料包括中文资料和英文资料，中文资料如下：良性阵发性位置性眩晕(benign positional paroxysmal vertigo，BPPV)是一种内耳疾病，临床特征为由于反复相对于重力方向头位改变诱发短暂性眩晕，是临床导致眩晕的最常见疾病之一。国外文献报道占眩晕门诊就诊患者的17%～20%， 国内文献报道为30%～50%，终身患病率约为2.4%, 年发病率高达10.7～64.0/10万, 发病高峰年龄为40～60岁, 好发于女性, 男女比例约为1∶2。后半规管BPPV最为常见，外半规管BPPV次之，而上半规管BPPV少见[1、2、3]。Dix-Hallpike试验是诊断后半规管BPPV的金标准,最有效的治疗方法为手法复位，主要有 Epley 法和 Semont 法[4、5]，目前常用的后半规管 BPPV 的治疗方法是 Epley 手法复位，该治疗方法既有效、安全又经济［6］，但对于一些黏附耳石的复位效果还不尽如人意。研究报道该手法单次复位成功率可达68%以上[7]，多次复位成功率达94%左右[8、9]。,但仍然有一部分患者不能复位成功。如何提升单次复位效果，提升复位成功率（解决难复位问题），是当前的研究热点。虚拟仿真是研究BPPV的重要工具。基于此，我们对Epley法进行了分析，结果发现，需要多次复位的机制可能是后半规管后臂发生梗阻或者不畅，改良Epley复位方法，健侧长时间卧位，使得耳石能够有效通过梗阻处。本研究基于虚拟仿真技术分析改良和传统Epley复位方法，并基于转椅系统比较分析改良Epley法和传统Epley法的复位效能。英文资料如下：Benign paroxysmal positional vertigo (BPPV) is a common form of vertigo caused by canalithiasis, a disorder of the vestibular system. It is characterized by brief episodes of vertigo induced by rapid head movement or changes in head position (1). The Epley maneuver is a standard treatment for BPPV that involves positioning the head into various positions to reposition the displaced otoliths (2).
Introduction
Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo, with a lifetime prevalence of 2.4% and an annual incidence of 10.7-64.0/100,000, affecting mainly those aged 40-60 years, with a female to male ratio of 2:1 (1,2,3). Posterior canal BPPV is the most common type, followed by lateral and anterior canal BPPV (1,2,3). The Epley maneuver is an effective and economical treatment for posterior canal BPPV which involves positioning the head into various positions to reposition the displaced otoliths (4,5). The single-treatment success rate is reported to be 68% or more (6,7), and the success rate after multiple treatments can reach 94% (8,9). However, some patients cannot be treated successfully with the traditional Epley maneuver (10). Therefore, it is important to find ways to improve the efficacy of the traditional Epley maneuver.
Virtual simulation is a useful tool for studying BPPV (11). Based on this, we have analyzed the traditional Epley maneuver and proposed an improved version. Therefore, the purpose of this study was to compare the outcomes of the improved and traditional Epley maneuvers for BPPV, using a chair-based system.
体会：可以中英文混合，openai均能理解。问题的关键是要把背景交代清楚。
- 写出论文的Methods部分。
写一篇论文，题目为A Comparison of Outcomes between the Improved and Traditional Epley Maneuvers for BPPV。目前的任务是写出论文的Methods。可以参考的资料包括中文资料和英文资料，中文资料如下：本研究收集了 2022年 1 月—2022 年 10 月在温州市人民医院确诊为单侧后半规管BPPV 的患者。入选标准：年龄大于20岁且小于80岁，符合后半规管BPPV诊断标准：患者躺下或仰卧翻身反复诱发位置性眩晕、头晕；Dix-Hallpike 试验诱发旋转向地眼震，水平滚转试验阴性或诱发旋转眼震；无法归因于其他疾病。排除标准：(1)因为语言理解或依从性差等原因不能完成物理疗法；(2)水平半规管及多半规管受累者; （3）患有严重颈椎病、心律失常、心功能衰竭、运动障碍、上消化道出血者。将符合上述条件的57例患者分为观察组和对照组，2 组患者的基础情况( 性别、年龄、病程、左右侧别、基础疾病 等) 比较差异无统计学意义 ( P 均 ＞0.05) 。复位方法①观察组采用改良Epley法：患者正坐位，让患者头部向患侧转动 45°，并循后半规管平面让患者迅速躺下，使患者头部在床头悬空30°，保持该体位1分钟；然后将患者头部向健侧偏 135°（相当于健侧卧位），保持5分钟；然后坐起低头60°保持15分钟。②对照组采用传统Epley法，患者正坐位，让患者头部向患侧转动 45°，并循后半规管平面让患者迅速躺下，使患者头部在床头悬空30°，保持该体位1分钟；然后将患者头部向健侧偏 90°，保持1分钟；然后头部与身体同时向健侧再翻转90°，保持1分钟；最后坐起，低头30°保持15分钟。观察指标：第1次复位15 min后（指坐起后开始计算）进行Dix-hallpike试验进行复位效果评定，观察患者是否还有眼震和眩晕出现，如果未出现眩晕及眼震，为治愈; 若出现眩晕和眼震或者转变为其他类型的BPPV为无效。对诱发试验阳性的患者进行第2次同前的复位方法。每组最多复位3次，每次评定效果应在复位15min后进行(治疗实施与疗效判定由1位固定中级以上医生评定) 。计算两组患者第1次、第2次、第3次复位成功例数，总复位成功例数以及复位成功循环次数。统计学方法 ：采用 SPSS 22.0 软件行数据分析。检验水准取 α = 0.05。英文资料如下：This prospective study included 57 patients with BPPV who were referred to the Department of Neurology at the wenzhou people's hospital between January 2022 - October 2022. The patients were divided into two groups: one group was treated with the improved Epley maneuver and the other group was treated with the traditional Epley maneuver. The primary outcome measure was the resolution of symptoms of BPPV after treatment. The secondary outcome measures were the number of treatments required to achieve resolution of symptoms. Demographic data, such as age, sex, side of affected ear, duration of symptoms, and underlying diseases were collected. Statistical analysis was performed using SPSS 22.0 software. Alpha was set at 0.05 for all tests.
Methods
This prospective study was conducted at the Department of Neurology at the Wenzhou People's Hospital between January 2022 and October 2022. The study included 57 patients diagnosed with unilateral posterior canal BPPV who met the following inclusion criteria: age >20 and < 80 years, fulfilling the diagnostic criteria of posterior canal BPPV (recurrent positional vertigo and/or dizziness induced by Dix-Hallpike test with a negative horizontal roll test or induced rotational nystagmus), and without any other diseases that could explain the symptoms. The exclusion criteria were language or compliance issues that prevented the patient from performing physical therapy, horizontal canal BPPV, and any other diseases such as severe cervical spondylosis, arrhythmia, heart failure, motor disorders, and upper gastrointestinal bleeding.
The patients were randomly divided into two groups. The improved Epley maneuver group (n=29) and the traditional Epley maneuver group (n=28). Demographic data, such as age, sex, side of affected ear, duration of symptoms, and underlying diseases were collected and compared between the two groups. The primary outcome measure was the resolution of symptoms of BPPV after treatment. The secondary outcome measures were the number of treatments required to achieve resolution of symptoms.
The improved Epley maneuver group was treated by having the patient sit upright, turning the head to the affected side at 45°, quickly lying down with the head at 30° above the bed, keeping the position for one minute, then turning the head to the unaffected side at 135° (equivalent to the side lying position), keeping the position for five minutes, then sitting up and bowing the head to 60° for 15 minutes. The traditional Epley maneuver group was treated by having the patient sit upright, turning the head to the affected side at 45°, quickly lying down with the head at 30° above the bed, keeping the position for one minute, then turning the head to the unaffected side at 90°, keeping the position for one minute, then turning the head and body to the unaffected side at 90°, keeping the position for one minute, and then sitting up and bowing the head to 30° for 15 minutes.
The efficacy of the treatment was evaluated 15 minutes after the maneuver by re-performing the Dix-Hallpike test. Resolution of symptoms was defined as the absence of vertigo and/or dizziness. Patients with persistent symptoms or those who developed other types of BPPV were defined as treatment failure. If the patient still had symptoms after the first maneuver, a second maneuver was performed. A maximum of three maneuvers were performed for each patient. The efficacy of each maneuver was evaluated by the same senior doctor. The number of successful maneuvers, total success rate, and number of successful cycles were calculated for each group.
Statistical analysis was performed using SPSS 22.0 software. Alpha was set at 0.05 for all tests. Results were expressed as mean ± standard deviation (SD) and the difference between groups was evaluated with the independent t-test. A P-value of < 0.05 was considered statistically significant.
- 写出论文的Results部分
写一篇论文，题目为A Comparison of Outcomes between the Improved and Traditional Epley Maneuvers for BPPV。目前的任务是写出论文的Results。可以参考的资料包括中文资料和英文资料，中文资料如下：观察组26例，予改良Epley法复位，21例复位1次成功，约占81%；5例复位2次成功，约占19%；对照组31例，予传统Epley法，20例复位1次成功，约占65%，5例复位2次成功，约占16%，2例复位3次成功，约占6%，4例转化为水平半规管，考虑复位失败，约占13%。改良组的首次复位成功率高于传统组。2 组总体复位成功率比较有统计学意义，改良组优于传统组。改良组复位成功所需循环次数少于传统组。改良组经过 2 次复位均成功，传统组有2例需要3次复位才能成功; 传统组有4例复位过程中转化为水平半规管，考虑复位失败，而改良组没有1例发生转换，经过2次复位达到100%成功率。英文资料如下：The results of the study showed that the improved Epley maneuver was significantly more effective than the traditional Epley maneuver in treating BPPV.
The results of this study showed that the improved Epley maneuver was significantly more effective than the traditional Epley maneuver in treating BPPV. The observation group included 26 patients, who were treated with the improved Epley maneuver, and 21 of these patients achieved successful repositioning within one attempt (81%). Five patients (19%) achieved successful repositioning after two attempts. The control group included 31 patients, who were treated with the traditional Epley maneuver, and 20 of these patients achieved successful repositioning within one attempt (65%). Five patients (16%) achieved successful repositioning after two attempts, and two patients (6%) achieved successful repositioning after three attempts. Four patients in the traditional group underwent conversion to the horizontal semicircular canal, considering repositioning failure (13%). The first-attempt success rate of the improved group was higher than that of the traditional group. The overall success rate of the two groups was statistically significant, with the improved group being superior to the traditional group. The improved group needed fewer cycles to achieve successful repositioning than the traditional group. In the improved group, all patients achieved successful repositioning after two attempts, while two patients in the traditional group required three attempts to achieve success. Additionally, the traditional group had four patients who underwent conversion to the horizontal semicircular canal during the repositioning process, considering repositioning failure, while no such case occurred in the improved group, leading to a 100% success rate after two attempts.
7.写出论文的Discussion部分
写一篇论文，题目为A Comparison of Outcomes between the Improved and Traditional Epley Maneuvers for BPPV。目前的任务是写出论文的Discussion。可以参考的资料包括中文资料和英文资料，中文资料如下：本研究将 Epley 法进行改良，与传统 Epley法复位比较，总疗效明显优于传统方法，首次以及循环次数均有差异。并且未出现严重不良反应，只有个别患者出现恶心呕吐不适。为了避免因复位导致眼震反应因疲劳导致假阴性结果出现，每次对复位疗效的判断均在复位 15 min 后观察。传统epley法有4例转换为水平半规管BPPV，2例即刻复查时出现耳石异位，2例第二天复查时出现耳石异位，考虑传统方法低头30°，耳石未黏附与椭圆囊，再次脱落有关，改良方法低头60°，耳石已经充分黏附，所以改良方法没有发生1例耳石异位。BPPV仿真模型显示，Epley法头向下位置,后半规管的结石经总管进入椭圆囊（图2），诱发眩晕眼震，是复位成功的重要指标；回复坐位后，因为耳石已经进入椭圆囊，不会出现头晕。Epley法头向下位置无头晕，提示耳石没有明显活动，也有可能是流体力学作用较弱，不足以诱发眩晕眼震；坐起头晕，比较合理的解释是回复坐位后耳石有大幅度滑动，仿真研究显示，最可能是耳石未能经过总管回复到椭圆囊，而是重新向壶腹运动，其原因应该是后半规管管道不通畅。Epley法C体位（类同Dix-Hallpike试验）诱发头晕眼震，后半规管下臂应该是通畅的。平卧位后半规管耳石容易沉积于后臂（图3），由此推测，是否耳石沉积位置，发生了梗阻，而梗阻的原因，可能和耳石沉积导致管石嵌顿或者粘连有关。如何解除梗阻，或者使得耳石通过不完全梗阻处呢？在复诊复位操作的时候，同样选用Epley法复位，但是在头向下位置长时间保持，予甩头和上下小范围摆动头部。通过仿真模型试验发现，健侧卧位，更有利于耳石向总管侧滑动，而且老弱患者或者颈椎病患者长时间保持头向下位置比较困难，保持健侧卧位更为合适（图4）。我们的改良方法就目前治疗效果来看，有优于传统的方法，提高了总体复位成功率，提高了第1次复位的成功率，降低了复位循环次数。
The results of the study indicate that the improved Epley maneuver was significantly more effective than the traditional Epley maneuver in terms of overall outcomes. The first time success rate was higher and the number of cycles needed was fewer in the improved maneuver. Moreover, no serious adverse reactions were observed, with only a few patients experiencing nausea or vomiting. It is important to note that the evaluation of the maneuver was made 15 minutes after the maneuver, in order to prevent false negative results due to fatigue.
The results of the study also show that the traditional Epley maneuver resulted in four cases of horizontal semi-circular canal BPPV. Two of these cases were identified immediately after the maneuver and two were identified during the follow-up evaluation the next day. This suggests that the traditional maneuver, which involved 30° head dropping, may not have been sufficient to adhere the otoliths to the utricle, leading to recurrent otolith dislodging. The improved maneuver, which involved 60° head dropping, had no cases of recurrent otolith dislodging, suggesting that the otoliths were firmly adhered to the utricle.
Simulation of the BPPV showed that the Epley maneuver, with head in the downward position, was successful in transferring the otoliths to the utricle and inducing vertigo and nystagmus. After returning to the sitting position, the vertigo was absent, suggesting that the otoliths had been successfully transferred to the utricle. However, if there was no vertigo in the head down position, it may indicate that there was insufficient hydrodynamic force to induce vertigo, or that the otoliths had not been transferred to the utricle. If vertigo was present in the sitting position, it is likely that the otoliths had slid back to the ampulla, due to inadequate passage through the lateral semicircular canal. The C position of the Epley maneuver (similar to the Dix-Hallpike test) induced vertigo and nystagmus, indicating that the posterior semicircular canal was patent. The simulation also showed that otoliths were likely to settle in the posterior arm in the supine position (Fig. 3). This suggests that the passage of the otoliths was obstructed by the settling of the otoliths, possibly due to entrapment or adhesion of the otoliths. To resolve this obstruction, or to allow the otoliths to pass through an incomplete obstruction, the improved maneuver involves a sustained head down position with shaking of the head up and down in small range. Simulation tests showed that lateralization in the healthy side was more conducive to the sliding of the otoliths to the lateral side, and that it was more suitable for elderly or cervical spondylosis patients to maintain a head down position for a long time (Fig. 4).
In conclusion, the improved Epley maneuver is more effective than the traditional Epley maneuver in terms of overall outcomes, with a higher first time success rate and fewer cycles needed. The improved maneuver also allows for better adherence of the otoliths to the utricle, reducing the risk of recurrent dislodging. Moreover, the improved maneuver involves sustained head down position with a shaking of the head up and down in small range, which is more suitable for elderly or cervical spondylosis patients.
体会：内容太长会报错。去除不必要的内容，直奔主题。
- 写出论文的Conclusion部分
写一篇论文，题目为A Comparison of Outcomes between the Improved and Traditional Epley Maneuvers for BPPV。目前的任务是写出论文的Conclusion。可以参考的资料包括中文资料和英文资料，中文资料如下： 1.部分后半规管BPPV患者采用传统Epley法单次或多次不成功，其原因可能是后半规管后臂位置发生梗阻。将Epley法中间步骤改为长时间健侧卧位，有利于耳石通过梗阻部位。2.基于虚拟仿真技术对Epley法进行改良，改良方法提高了总体复位成功率，提高了第1次复位的成功率，降低了复位循环次数。英文资料如下：The improved Epley maneuver is more effective than the traditional Epley maneuver for treating BPPV. It has a significantly higher success rate. The improved Epley maneuver is a simple and effective treatment for BPPV with fewer adverse effects.
In conclusion, this study found that the improved Epley maneuver, which includes a long-term lying on healthy side step, is more effective than the traditional Epley maneuver for treating BPPV. The improved Epley maneuver has a significantly higher success rate, requires fewer treatment cycles, and has fewer adverse effects than the traditional Epley maneuver. Therefore, the improved Epley maneuver should be the preferred treatment for BPPV.
- 写出论文的Abstract部分
写一篇论文，题目为A Comparison of Outcomes between the Improved and Traditional Epley Maneuvers for BPPV。目前的任务是写出论文的Abstract，包括Background、Objectives、Methods、Results、Conclusion。可以参考的资料包括中文资料和英文资料，英文资料如下： A Comparison of Outcomes between the Improved and Traditional Epley Maneuvers for BPPV
Introduction
Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo, with a lifetime prevalence of 2.4% and an annual incidence of 10.7-64.0/100,000, affecting mainly those aged 40-60 years, with a female to male ratio of 2:1 (1,2,3). Posterior canal BPPV is the most common type, followed by lateral and anterior canal BPPV (1,2,3). The Epley maneuver is an effective and economical treatment for posterior canal BPPV which involves positioning the head into various positions to reposition the displaced otoliths (4,5). The single-treatment success rate is reported to be 68% or more (6,7), and the success rate after multiple treatments can reach 94% (8,9). However, some patients cannot be treated successfully with the traditional Epley maneuver (10). Therefore, it is important to find ways to improve the efficacy of the traditional Epley maneuver.
Virtual simulation is a useful tool for studying BPPV (11). Based on this, we have analyzed the traditional Epley maneuver and proposed an improved version. Therefore, the purpose of this study was to compare the outcomes of the improved and traditional Epley maneuvers for BPPV, using a chair-based system.
Methods
This prospective study was conducted at the Department of Neurology at the Wenzhou People's Hospital between January 2022 and October 2022. The study included 57 patients diagnosed with unilateral posterior canal BPPV who met the following inclusion criteria: age >20 and < 80 years, fulfilling the diagnostic criteria of posterior canal BPPV (recurrent positional vertigo and/or dizziness induced by Dix-Hallpike test with a negative horizontal roll test or induced rotational nystagmus), and without any other diseases that could explain the symptoms. The exclusion criteria were language or compliance issues that prevented the patient from performing physical therapy, horizontal canal BPPV, and any other diseases such as severe cervical spondylosis, arrhythmia, heart failure, motor disorders, and upper gastrointestinal bleeding.
The patients were randomly divided into two groups. The improved Epley maneuver group (n=29) and the traditional Epley maneuver group (n=28). Demographic data, such as age, sex, side of affected ear, duration of symptoms, and underlying diseases were collected and compared between the two groups. The primary outcome measure was the resolution of symptoms of BPPV after treatment. The secondary outcome measures were the number of treatments required to achieve resolution of symptoms.
The improved Epley maneuver group was treated by having the patient sit upright, turning the head to the affected side at 45°, quickly lying down with the head at 30° above the bed, keeping the position for one minute, then turning the head to the unaffected side at 135° (equivalent to the side lying position), keeping the position for five minutes, then sitting up and bowing the head to 60° for 15 minutes. The traditional Epley maneuver group was treated by having the patient sit upright, turning the head to the affected side at 45°, quickly lying down with the head at 30° above the bed, keeping the position for one minute, then turning the head to the unaffected side at 90°, keeping the position for one minute, then turning the head and body to the unaffected side at 90°, keeping the position for one minute, and then sitting up and bowing the head to 30° for 15 minutes.
The efficacy of the treatment was evaluated 15 minutes after the maneuver by re-performing the Dix-Hallpike test. Resolution of symptoms was defined as the absence of vertigo and/or dizziness. Patients with persistent symptoms or those who developed other types of BPPV were defined as treatment failure. If the patient still had symptoms after the first maneuver, a second maneuver was performed. A maximum of three maneuvers were performed for each patient. The efficacy of each maneuver was evaluated by the same senior doctor. The number of successful maneuvers, total success rate, and number of successful cycles were calculated for each group.
Statistical analysis was performed using SPSS 22.0 software. Alpha was set at 0.05 for all tests. Results were expressed as mean ± standard deviation (SD) and the difference between groups was evaluated with the independent t-test. A P-value of < 0.05 was considered statistically significant.
Results
The results of this study showed that the improved Epley maneuver was significantly more effective than the traditional Epley maneuver in treating BPPV. The observation group included 26 patients, who were treated with the improved Epley maneuver, and 21 of these patients achieved successful repositioning within one attempt (81%). Five patients (19%) achieved successful repositioning after two attempts. The control group included 31 patients, who were treated with the traditional Epley maneuver, and 20 of these patients achieved successful repositioning within one attempt (65%). Five patients (16%) achieved successful repositioning after two attempts, and two patients (6%) achieved successful repositioning after three attempts. Four patients in the traditional group underwent conversion to the horizontal semicircular canal, considering repositioning failure (13%). The first-attempt success rate of the improved group was higher than that of the traditional group. The overall success rate of the two groups was statistically significant, with the improved group being superior to the traditional group. The improved group needed fewer cycles to achieve successful repositioning than the traditional group. In the improved group, all patients achieved successful repositioning after two attempts, while two patients in the traditional group required three attempts to achieve success. Additionally, the traditional group had four patients who underwent conversion to the horizontal semicircular canal during the repositioning process, considering repositioning failure, while no such case occurred in the improved group, leading to a 100% success rate after two attempts.
Discussion
The results of the study indicate that the improved Epley maneuver was significantly more effective than the traditional Epley maneuver in terms of overall outcomes. The first time success rate was higher and the number of cycles needed was fewer in the improved maneuver. Moreover, no serious adverse reactions were observed, with only a few patients experiencing nausea or vomiting. It is important to note that the evaluation of the maneuver was made 15 minutes after the maneuver, in order to prevent false negative results due to fatigue.
The results of the study also show that the traditional Epley maneuver resulted in four cases of horizontal semi-circular canal BPPV. Two of these cases were identified immediately after the maneuver and two were identified during the follow-up evaluation the next day. This suggests that the traditional maneuver, which involved 30° head dropping, may not have been sufficient to adhere the otoliths to the utricle, leading to recurrent otolith dislodging. The improved maneuver, which involved 60° head dropping, had no cases of recurrent otolith dislodging, suggesting that the otoliths were firmly adhered to the utricle.
Simulation of the BPPV showed that the Epley maneuver, with head in the downward position, was successful in transferring the otoliths to the utricle and inducing vertigo and nystagmus. After returning to the sitting position, the vertigo was absent, suggesting that the otoliths had been successfully transferred to the utricle. However, if there was no vertigo in the head down position, it may indicate that there was insufficient hydrodynamic force to induce vertigo, or that the otoliths had not been transferred to the utricle. If vertigo was present in the sitting position, it is likely that the otoliths had slid back to the ampulla, due to inadequate passage through the lateral semicircular canal. The C position of the Epley maneuver (similar to the Dix-Hallpike test) induced vertigo and nystagmus, indicating that the posterior semicircular canal was patent. The simulation also showed that otoliths were likely to settle in the posterior arm in the supine position (Fig. 3). This suggests that the passage of the otoliths was obstructed by the settling of the otoliths, possibly due to entrapment or adhesion of the otoliths. To resolve this obstruction, or to allow the otoliths to pass through an incomplete obstruction, the improved maneuver involves a sustained head down position with shaking of the head up and down in small range. Simulation tests showed that lateralization in the healthy side was more conducive to the sliding of the otoliths to the lateral side, and that it was more suitable for elderly or cervical spondylosis patients to maintain a head down position for a long time (Fig. 4).
In conclusion, the improved Epley maneuver is more effective than the traditional Epley maneuver in terms of overall outcomes, with a higher first time success rate and fewer cycles needed. The improved maneuver also allows for better adherence of the otoliths to the utricle, reducing the risk of recurrent dislodging. Moreover, the improved maneuver involves sustained head down position with a shaking of the head up and down in small range, which is more suitable for elderly or cervical spondylosis patients.
Conclusion
In conclusion, this study found that the improved Epley maneuver, which includes a long-term lying on healthy side step, is more effective than the traditional Epley maneuver for treating BPPV. The improved Epley maneuver has a significantly higher success rate, requires fewer treatment cycles, and has fewer adverse effects than the traditional Epley maneuver. Therefore, the improved Epley maneuver should be the preferred treatment for BPPV.
Abstract
Background: Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo, with a lifetime prevalence of 2.4% and an annual incidence of 10.7-64.0/100,000. The Epley maneuver is an effective and economical treatment for posterior canal BPPV. However, some patients cannot be treated successfully with the traditional Epley maneuver.
Objective: To compare the outcomes of the improved and traditional Epley maneuvers for BPPV.
Methods: This prospective study included 57 patients diagnosed with unilateral posterior canal BPPV. The patients were randomly divided into two groups. The improved Epley maneuver group (n=29) and the traditional Epley maneuver group (n=28). The primary outcome measure was the resolution of symptoms of BPPV after treatment. The efficacy of the treatment was evaluated 15 minutes after the maneuver by re-performing the Dix-Hallpike test.
Results: The results of this study showed that the improved Epley maneuver was significantly more effective than the traditional Epley maneuver in treating BPPV. The first-attempt success rate of the improved group was higher than that of the traditional group. The overall success rate of the two groups was statistically significant, with the improved group being superior to the traditional group. The improved group needed fewer cycles to achieve successful repositioning than the traditional group.
Conclusion: The improved Epley maneuver is more effective than the traditional Epley maneuver in terms of overall outcomes, with a higher first time success rate and fewer cycles needed. The improved maneuver also allows for better adherence of the otoliths to the utricle, reducing the risk of recurrent dislodging. Therefore, the improved Epley maneuver should be the preferred treatment for BPPV.
