Epley maneuver versus 360° maneuver for treatment of posterior canal benign paroxysmal positional vertigo in a mechanical rotation chair: a randomized controlled trial.

OBJECTIVE: To compare the treatment efficacy of the Epley maneuver and the 360° maneuver in a cohort diagnosed with posterior benign paroxysmal positional vertigo (BPPV) using a mechanical rotation chair (MRC). STUDY DESIGN: Open-label parallel group randomized controlled trial. SETTING: Tertiary university hospital-based outpatient clinic. PARTICIPANTS: Adults (n = 102) diagnosed with unilateral posterior BPPV. INTERVENTIONS: Participants were randomized to treatment with either the Epley- or the 360° maneuver. Follow-up visits were scheduled biweekly until treatment was successful or up to five treatments were given. By use of questionnaires, patient-reported outcome measures were assessed at baseline and after successful treatment. Subjective recurrences were assessed at 3- and 6-month follow-up questionnaires. MAIN OUTCOME MEASURES: Primary outcome: treatment success after one treatment. Secondary outcomes: number of treatments to obtain treatment success, Dizziness Handicap Inventory (DHI), visual analogue scale (VAS) of vertigo, maneuver tolerability, and subjective recurrence. RESULTS: Treatment success after one treatment was comparable between the groups (risk difference (RD): -0.12 (95% confidence interval (CI): -0.32, 0.07)). The cumulative probability of treatment success across treatments showed no clear difference between groups (hazard ratio: 0.77, 95% CI: 0.50, 1.21). Both groups showed clinically meaningful improvements in DHI and VAS of vertigo, with no between-group differences. Subjective recurrence rates were also similar. CONCLUSION: Epley- and 360° maneuvers with an MRC demonstrated similar treatment efficacy across objective and patient-reported outcomes, suggesting flexibility in the maneuver choice. Further research should investigate optimization of treatment protocols and long-term follow-up regarding recurrence patterns. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/, identifier NCT05834452.