A Comparison of Two Home Exercisesfor Benign Positional Vertigo:Half Somersault versus Epley Maneuver

Carol A. Fostera Annand Ponnapanb Kathleen Zaccaroc Darcy Strongc

Departments of aOtolaryngology and Audiology, bOtolaryngology, and cAudiology, School of Medicine,University of Colorado Denver, Aurora, Colo. , USA

Muhammad Ulin Nuha01.210.6229

IntroductionBPPVPosteriorHorizontalAnteriorRecurrences (50%)1-3 yearsIn the 1980s, two treatments for the posterior canal variant, the Epley and Semont maneuvers, were independently devised, and both have been found to be similar in efficacy, which exceeds 90% [Epley, 1992; Semont et al., 1988; White et al., 2005].The initial step in the Epley maneuver is the Dix Hallpike (DH) maneuver, a variation of which is also used in the Semont maneuver [Epley, 1992].

*Half Somersault have not the same limitation like Eply Manuever and reduce recurrence.This is useful in diagnosis because it places the patients eyes in a favorable position for viewing by the physician, and it is designed to trigger a particularly severe spell of nystagmus that is thus more easily observed.Limitation of Eply Manuevercauses dizziness that can be severe enough to cause vomiting.the possibility become horizontal canal BPPV (H-BPPV)The Epley maneuver requires an operator and often a second assistant to guide the patient through the proper positions.

Fig. 1. Half somersault for right sided BPPV. After each position change, any dizziness is allowed to sub-side before moving into the next position; if there is no dizziness, the position should be held for 15 s. A While kneeling, the head is quickly tipped upward and back. B The somersault position is assumed, with the chin tucked as far as possible toward the knee. C The head is turned about 45 toward the right shoul-der, to face the right elbow. D Maintaining the head at 45, the head is raised to back/shoulder level. E Maintaining the head at 45, the head is raised to the fully upright position. Dark curved arrows show head movements. Lighter arrows near eyes show the direction one should be facing.

Parameter;Intensity Of NistagmusDizzines Induced ExerciseRecurrenses

Patients and MethodsThis was a prospective, controlled, randomized, single-blinded clinical trial.

We see over 200 BPPV patients per year in this clinic and perform maneuvers on all patients with BPPV of either the horizontal or vertical canal varieties.

Inclusion Criteria

18 years of age or olderA history of symptoms suggestive of BPPVNystagmus and axis of ocular rotation consistent with unilateral posterior canal BPPV.

*Diagnosis was performed by direct visualization of the globes during the DH maneuver. Exclusion Criteria

Patients with cupulolithiasisH-BPPV or bilateral BPPVnystagmus of any other direction stemming from other peripheral or central vestibular disorders a history of BPPV symptoms but without visible nystagmus on DHpatients who were unable to bend the neck or turn the head safely, sit up, lie down, roll over or kneel on hands and knees

Subject Number :49 females and 19 males.Scoring

presence and intensity of nystagmus was recorded using a 15 scale (Nystagmus Intensity Score) Subjects were asked to rate the severity of the dizziness they experienced during their exercises on a 15 scale (Exercise-induced Dizziness Score)A diagnostic DH was performed in a treatment room by the PI, and the presence and intensity of nystagmus was recorded using a 15 scale (nystagmus intensity score)randomEM : 35H-S M : 33Subjects were asked to rate the severity of the dizziness they experienced during their exercises on a 15 scale (exercise-induced dizziness score)All patients then waited 15 min prior to returning to the original treatment room. The PI was blinded as to the maneuver type that the patient had learned and used. A DH was then performed by the PI, and the presence, duration and intensity of any remaining nystagmus was again recorded using a 15 scale.Six months after initial treatment, the log sheets were collected and each subject was contacted, their clinical chart was reviewed for recurrences,The subjects were provided with a log sheet to record recurrences and treatment results and were instructed to perform their assigned exercise with any recurrence.

Result

Epley ManueverHalf SomersaultNystagmus Intensity Pre-treatment3.51 0.88 (meanSD)3.61 0.97 (mean SD)EM and H-SM was not significant (p = 0.684)Nystagmus Intensity Post-treatment1.11 1.17, 68% reduction. (p < 0.0001)2.11 1.57, 42% reduction. (p < 0.0001)EM < H-SM (p = 0.004)Exercise-induced Dizziness 2.17 1.20. 13/35 (37%)1.61 1.11. 9/33 (27%)H-SM < EM (p = 0.049)Recurrences21 recurrences occurred in 15/30 (50%)12 recurrences in 10/27 (37%)Not Significant(p = 0.236)

DiscussionOur study shows that both exercises are efficacious when used as a home exercise for patients

The subjects in this study had a resolution rate of only 37% after two Epley maneuvers and 27% after two half somersaults.

The half somersault was not as effective as the Epley in reducing nystagmus intensity with two maneuvers, an indicator of a reduction in particle burden in the posterior semicircular canal, and this difference was statistically significant.

The subjects reported more dizziness during the Epley than during the half somersault exercise and this difference was also statistically significant.

The Epley group was significantly more likely to experience a treatment failure using home exercises for recurrences than the half somersault group, and only members of the Epley group discontinued using exercises, returned to the clinic for treatment, or experienced H-BPPV.

These results suggest that patients prefer the less effective exercise because they experience less dizziness when applying it and experience fewer complications.

JUDUL JURNALA Comparison of Two Home Exercises for Benign Positional Vertigo: Half Somersault versus Epley Maneuver

Judul :MenarikTidak menggunakan singkatanTerdiri dari 2 variable ( bebas dan terikat )Sudah sesuai dengan isi penelitian

ABSTRAK

TERDIRI DARI :TUJUAN, METODE, HASIL, KESIMPULAN

PENULIS

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