Short-Term Effect of Epley Maneuver as Treatment for Subjective Benign Paroxysmal Positional Vertigo


Subjective Benign Paroxysmal Positional Vertigo (S-BPPV) is an atypical form of BPPV, its treatment is not well characterized and is not well known among otolaryngologists. The main aim of this study was to estimate the short-term efficacy of Epley maneuver as treatment for S-BPPV. This was a prospective study in a secondary care center. We included patients with unilateral S-BPPV demonstrated by negative nystagmus on Dix-Hallpike Maneuver (DHM) but with unilateral vestibular symptoms (dizziness or vertigo). Epley maneuver to the affected side was performed. Patients underwent Dizziness Handicap Inventory (DHI) and at 1-week follow-up, DHI and DHM were repeated. Outcome measures were resolution of symptoms during DHM and improvement of DHI scores. Patients were divided into resolved and unresolved groups according to the absence or presence of symptoms during the 1 week DHM. Wilcoxon-Mann–Whitney and Kruskal–Wallis tests were used, quantitative values were reported as mean and standard deviation. The results included thirteen participants, 12 females and 1 male, mean age 53.31 years (SD ± 15.71). Right ear was involved in 46.15% and left in 53.84%. A total of 46.15% patients (n = 6) had resolution of symptoms. DHI initial score for the resolved group was 34.66 ± 22 and for the unresolved group was 39.71 ± 19.61 (p = 0.568). At 1-week evaluation scores were 19.66 ± 25.05 for the resolved group and 30.28 ± 21.42 for the unresolved group (p = 0.252). DHI improvement was 15.00 ± 23.21 and 9.42 ± 10.17 for each group, respectively (p = 0.943). We concluded the Epley maneuver is an effective short-term treatment for S-BPPV. Half of the patients would need further diagnostic tests.

This is a preview of subscription content, access via your institution.


  1. 1.

    Silva C, Amorim AM, Paiva A (2015) Benign Paroxysmal Positional Vertigo: revision of 101 cases. Acta Otorrinolaringol Esp 66(4):205–209

    Article  Google Scholar 

  2. 2.

    You P, Instrum R, Parnes L (2018) Benign Paroxysmal Positional Vertigo. Laryngoscope Investig Otolaryngol 4(1):116–123

    Article  Google Scholar 

  3. 3.

    Wang YH, Chan YC, Liu QH (2019) Benign paroxysmal positional vertigo—recommendations for treatment in primary care. Ther Clin Risk Manag 2019(15):719–725

    Article  Google Scholar 

  4. 4.

    Ciorba A, Cogliandolo C, Bianchini C et al (2019) Clinical features of benign paroxysmal positional vertigo of the posterior semicircular canal. SAGE Open Med 7:1–5

    Article  Google Scholar 

  5. 5.

    Haynes DS, Resser JR, Labadie RF et al (2002) Treatment of benign positional vertigo using the Semont maneuver: efficacy in patients presenting without nystagmus. Laryngoscope 112(5):796–801

    Article  Google Scholar 

  6. 6.

    Munaro G, Silveira AF (2009) Vestibular evaluation in typical and atypical benign paroxysmal positional vertigo. Rev CEFAC 11(1):76–84

    Article  Google Scholar 

  7. 7.

    Von Brevern M, Bertholon P, Brandt T, Fife T, Imai T, Nuti D et al (2015) Benign paroxysmal positional vertigo: diagnostic criteria. J Vestib Res 25(3–4):105–117

    Article  Google Scholar 

  8. 8.

    Büki B (2014) Benign Paroxysmal Positional Vertigo—Toward New Definitions. Otol Neurotol 35(2):323–328

    Article  Google Scholar 

  9. 9.

    Büki B, Mandala M, Nuti D (2014) Typical and atypical benign paroxysmal positional vertigo: literature review and new theoretical considerations. J Vestib Res 24(5):415–423

    Article  Google Scholar 

  10. 10.

    Karle M, Fernández R, Bahamonde S (2014) Subjective Benign Paroxysmal Positional Vertigo. Rev Otorrinolaringol Cir Cabeza Cuello 74(3):283–286

    Article  Google Scholar 

  11. 11.

    Tirelli G, D’Orlando E, Giacomarra V et al (2001) Benign Positional Vertigo Without Detectable Nystagmus. Laryngoscope 111(6):1053–1056

    CAS  Article  Google Scholar 

  12. 12.

    Jung JY, Kim SH (2016) Comparison between objective and subjective benign paroxysmal positional vertigo: clinical features and outcomes. Acta Otolaryngol 136(12):1267–1272

    Article  Google Scholar 

  13. 13.

    Balatsouras DG, Korres SG (2011) Subjective Benign Paroxysmal Positional Vertigo. Otol Neurotol 146(1):98–103

    Google Scholar 

  14. 14.

    Benito J, Poncela M, Díez L et al (2017) Practice Guidelines for Benign Paroxysmal Positional Vértigo. Rev ORL 8(3):157–196

    Article  Google Scholar 

  15. 15.

    González R, Domènech E, Álvarez MG et al (2018) Subjective benign paroxysmal positional vertigo in patients with osteoporosis or migraine. Braz J Otorhinolaryngol 86(1):83–90

    Article  Google Scholar 

  16. 16.

    Uz U, Uz D, Akdal G et al (2019) Efficacy of Epley maneuver on quality of life of elderly patients with subjective BPPV. J Int Adv Otol 15(3):420–424

    Article  Google Scholar 

  17. 17.

    Staab JP (2020) Persistent postural-perceptual dizziness. Semin Neurol 40(01):130–137

    Article  Google Scholar 

  18. 18.

    Huebner AC, Lytle SR, Doettl SM et al (2013) Treatment of objective and subjective benign paroxysmal positional vertigo. J Am Acad Audiol 24(7):600–606

    Article  Google Scholar 

  19. 19.

    Alvarenga GA, Barbos MA, Porto CC (2011) Benign Paroxysmal Positional Vertigo without nystagmus: diagnosis and treatment. Braz J Otorhinolaryngol 77(6):799–804

    Article  Google Scholar 

Download references



Author information



Corresponding author

Correspondence to Erika Maria Celis-Aguilar.

Ethics declarations

Conflict of interest

There are no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This study will be presented at the Virtual Conference AAOHNS 2020, as an oral presentation.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Celis-Aguilar, E.M., Medina-Cabrera, C.A., Torrontegui-Zazueta, L.A. et al. Short-Term Effect of Epley Maneuver as Treatment for Subjective Benign Paroxysmal Positional Vertigo. Indian J Otolaryngol Head Neck Surg (2021).

Download citation


  • Vestibular diseases
  • Benign Paroxysmal Positional Vertigo
  • Epley maneuver
  • Benign Paroxysmal Positional Vertigo therapy
  • Peripheral vertigo