Testing the Epley Maneuver for Treating Dizziness in the Emergency Department: A Randomized Study

NCT07111000 | Not Yet Recruiting DMC

• 1 other identifier: BIO-2023-0184
• Study Type: interventional
• Target: 118
• Locations: 0 countries
• Sites: N/A

Brief Summary

The goal of this randomized controlled trial is to evaluate the efficacy of the Epley maneuver versus a sham maneuver in treating patients presenting to the emergency department (ED) with BPPV. The main questions that the study aims to answer are:

• What is the mean difference in Dizziness Handicap Inventory (DHI) scores between patients receiving the Epley maneuver and those receiving the sham maneuver 3 days after enrollment?
• What is the immediate response (using a 0-10-point Likert scale) of patients in each arm of the study?
• What is the proportion of patients who, despite agreeing to participate, were unable to complete the full Epley maneuver due to symptom severity? Researchers will compare the Epley maneuver arm to the sham maneuver arm to see if the Epley maneuver is more effective in reducing BPPV symptoms. Participants will:
• Undergo either the Epley maneuver or a sham maneuver.
• Complete the Dizziness Handicap Inventory (DHI) questionnaire at baseline and 3 days post-discharge.
• Patients with insufficient improvement in the sham maneuver group will receive a rescue Epley maneuver.
• Have their vertigo severity assessed using a 0-10 point Likert scale at baseline, immediately and post-maneuver.

Conditions

Benign Paroxysmal Positional Vertigo (BPPV)

Keywords

Benign Paroxysmal Positional Vertigo (BPPV), vertigo, Epley maneuver, Dix-Hallpike Test (DHT)

Outcome Measures

Primary Outcomes (1)

• Efficacy of Epley

  The study will compare the average Dizziness Handicap Inventory score change from baseline to day 3 between the Epley maneuver group and the sham maneuver group.

  3 days

Secondary Outcomes (3)

• Immediate response of patients

  15-30 minutes after intervention

• Rate of bounce-back to the ED

  3 days

• Proportion of patients unable to undergo the full Epley maneuver

  15 minutes

Study Arms (2)

Epley Maneuver

EXPERIMENTAL

The patient's head is turned 45 degrees towards the side that caused the most nystagmus or reproduced their initial symptoms. The patient is then laid down with their head hanging over the edge of the bed. After that, the head will be rotated 90 degrees in the opposite direction, with the head remaining in a dependent position. The patient is then asked to roll onto their side with their head facing downward. They are then brought back to a sitting position and the head is moved forward 45 degrees. Each position is held until the vertigo and/or nystagmus subsides or for at least 30 seconds

Procedure: Epley Maneuver

Sham Maneuver

SHAM COMPARATOR

Procedure: Sham maneuver

Interventions

Epley Maneuver PROCEDURE

The patient's head is turned 45 degrees towards the side that caused the most nystagmus or reproduced their initial symptoms. The patient is then laid down with their head hanging over the edge of the bed. After that, the head will be rotated 90 degrees in the opposite direction, with the head remaining in a dependent position. The patient is then asked to roll onto their side with their head facing downward. They are then brought back to a sitting position and the head is moved forward 45 degrees. Each position is held until the vertigo and/or nystagmus subsides or for at least 30 seconds

Epley Maneuver

Sham maneuver PROCEDURE

This control maneuver will involve coordinated movements of the hands and legs, while excluding any head movement. Patients will be at first in a sitting position with both feet on the ground and both hands placed on the thighs and then they will be asked to lift both hands off the thighs, keeping the arms extended. They will then be asked to return to their initial upright sitting position. Patients will then raise their right foot off the ground while keeping the left one planted on the ground. It will be an alternating movement between lifting the right and left feet while maintaining a smooth and well- controlled rhythm for 90 seconds.

Sham Maneuver

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

Patients presenting to the ED with symptoms of BPPV (single or recurrent episodes of vertigo lasting up to 2 minutes) and a positive DHT (episode of vertigo associated with torsional upbeating nystagmus) indicating a posterior semicircular canal BPPV. Patients who are able to understand and provide a signed informed consent to participate in the study

Contact the study team to discuss eligibility requirements. They can help determine if this study is right for you.

Sponsors & Collaborators

• American University of Beirut Medical Center: lead

MeSH Terms

Conditions

Benign Paroxysmal Positional Vertigo; Vertigo

Condition Hierarchy (Ancestors)

Vestibular Diseases; Labyrinth Diseases; Ear Diseases; Otorhinolaryngologic Diseases; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Central Study Contacts

Eveline Hitti, MD

CONTACT

00961-1-350000; eh16@aub.edu.lb

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, CARE PROVIDER
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor of Clinical Specialty

Study Record Dates

• First Submitted: August 6, 2025
• First Posted: August 8, 2025
• Study Start: September 1, 2025
• Primary Completion (Estimated): July 22, 2026
• Study Completion (Estimated): August 22, 2026
• Last Updated: August 8, 2025

Record last verified: 2024-12