title: Patients with benign paroxysmal positional vertigo and cervical spine problems: is Epley's manoeuvre contraindicated, and is a proposed new manoeuvre effective and safer?
abstract: BACKGROUND
  Benign paroxysmal positional vertigo is one of the commonest peripheral vestibular causes of vertigo. The particle repositioning manoeuvre (Epley's manoeuvre) has become the 'gold standard' treatment for this disorder. Benign paroxysmal positional vertigo can affect any age group but is commoner in older patients. Cervical spine problems (e.g. spondylosis and disc prolapse) are commoner in this age group. Epley's manoeuvre necessitates passive neck movements. Such movements may not be wise in patients at risk of cervical spine fracture.
  
  
  METHODS
  This study included 40 patients complaining of vertigo and diagnosed as having benign paroxysmal positional vertigo. A new particle repositioning manoeuvre was designed for these patients, as an alternative to Epley's manoeuvre.
  
  
  RESULTS
  At one week review, 36 patients (90 per cent) reported total relief from vertigo. Three patients reported a major improvement in their vertigo, and their residual vertigo was relieved by performing the new manoeuvre again after two weeks. Further clinical reviews at one month, three months, six months and one year found that seven patients had suffered minor attacks of typical benign paroxysmal positional vertigo after three months. All seven were relieved of their symptoms after undergoing the new particle repositioning manoeuvre again.
  
  
  CONCLUSIONS
  The proposed new manoeuvre is simple, effective and safe for treating patients with benign paroxysmal positional vertigo and cervical spine problems.
authors.affiliation: ENT Department, Faculty of Medicine, Assiut University, Egypt. urashad2008@yahoo.com
authors.forename: U M
authors.initials: UM
authors.lastname: Rashad
mesh_terms: D000367:Age Factors; D000368:Aged; D065635:Benign Paroxysmal Positional Vertigo; D001915:Braces; D002574:Cervical Vertebrae; D004244:Dizziness / Q000209:etiology; D005260:Female; D019416:Head Movements / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009759:Nystagmus, Pathologic / Q000503:physiopathology; D026741:Physical Therapy Modalities; D011187:Posture / Q000502:physiology; D012399:Rotation / Q000009:adverse effects*; D012665:Semicircular Canals; D013122:Spinal Diseases / Q000150:complications*; D016896:Treatment Outcome; D014717:Vertigo / Q000150:complications / Q000628:therapy