Background:
Benign Paroxysmal Positional Vertigo (BPPV) of the posterior canal is commonly treated using the Epley Maneuver (EM). New maneuvers have been developed with potential benefits in ease and self-administration.
Objective:
To evaluate and compare the effectiveness of the Epley Maneuver with newly developed alternative maneuvers for treating posterior canal BPPV.
Methods:
We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing EM or placebo with new treatment maneuvers for posterior canal BPPV. Electronic databases (Scopus, PubMed, ScienceDirect, OVID MEDLINE, PROSPERO, and Cochrane Library) were searched. A pairwise meta-analysis using random-effects models was performed, and risk difference (RD) with 95% confidence intervals (CI) was calculated. Doi plots and the Luis Furuya-Kanamori (LFK) index were used to assess publication bias.
Results:
Five RCTs involving 422 patients were identified; three studies met criteria for meta-analysis. The pooled immediate treatment effect showed a rate ratio of 1.66 (95% CI: 0.534–5.151), and the follow-up effect showed a rate ratio of 1.64 (95% CI: 0.520–5.152), indicating that the new maneuvers (Half Somersault, Li Maneuver, and other alternates) demonstrated treatment outcomes comparable to the Epley Maneuver, while the wide confidence intervals reflect the limited number of available studies. The LFK indices were 1.74 (immediate) and 2.16 (follow-up), suggesting minor and major publication bias, respectively.
Conclusions:
Preliminary evidence suggests that newly developed maneuvers for posterior canal BPPV may offer comparable short-term and 6–12-month outcomes to the Epley Maneuver. These techniques appear simple, self-administered, and generally well-tolerated, indicating their potential as alternative options to the traditional EM; however, more robust and maneuver-specific studies are needed before firm conclusions can be drawn.
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