title: Effect of a hybrid maneuver in treating posterior canal benign paroxysmal positional vertigo.
abstract: BACKGROUND
  Benign paroxysmal positional vertigo (BPPV) is the most common disorder of the vestibular system of the inner ear, which is a vital part of maintaining balance. Although the efficacy of the Epley maneuver-also known as the canalith repositioning maneuver (CRM)-is well established, data comparing CRM versus a hybrid treatment are lacking.
  
  
  OBJECTIVE
  The purpose of this study was to determine the effect of a hybrid treatment, the Gans repositioning maneuver (GRM) either with or without postmaneuver restrictions, compared with CRM on treatment of posterior canal BPPV (PC-BPPV).
  
  
  METHODS
  Study design was a randomized controlled trial.
  
  
  METHODS
  A total of 45 patients (30 males and 15 females) with unilateral PC-BPPV were randomly allocated to one of three equal groups on the basis of the date of the first visit with matched assignment for gender: a GRMR group (GRM with postmaneuver restrictions), a GRM group, and a CRM group.
  
  
  METHODS
  Patients received weekly administration of the maneuver until resolution of symptoms. The Dix-Hallpike test was performed before treatment at every appointment, and finally after 1 mo from the last maneuver.
  
  
  METHODS
  Nystagmus duration and vertigo intensity were recorded. The supine roll test was performed in case the Dix-Hallpike test was negative to test otoconial migration. Data were analyzed with repeated-measures analysis of variance, paired t-tests with a Bonferroni correction, and the Spearman rank correlation coefficient.
  
  
  RESULTS
  All patients showed improvement within the groups, and PC-BPPV symptoms were resolved by an average of 2, 1.7, and 1.6 maneuvers for GRMR, GRM, and CRM, respectively, with no statistical differences among the three groups (p > 0.05). Only two patients had recurrence, and one patient had horizontal BPPV at 1 mo follow-up.
  
  
  CONCLUSIONS
  We demonstrated that the GRM as a new treatment is effective in treating PC-BPPV with no benefits to postmaneuver restrictions.
authors.affiliation: Department of Physical Therapy for Neuromuscular Disorder and its Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt.
authors.forename: Wanees M A
authors.initials: WM
authors.lastname: Badawy
authors.affiliation: Department of Physical Therapy for Neuromuscular Disorder and its Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt.
authors.forename: Ebtessam K
authors.initials: EK
authors.lastname: Gad El-Mawla
authors.affiliation: Military Medical Academy, Cairo, Egypt.
authors.forename: Ahmed E F
authors.initials: AE
authors.lastname: Chedid
authors.affiliation: Elmokatam Hospital, Cairo, Egypt.
authors.forename: Ahmed H A
authors.initials: AH
authors.lastname: Mustafa
mesh_terms: D000328:Adult; D065635:Benign Paroxysmal Positional Vertigo / Q000628:therapy*; D005260:Female; D019416:Head Movements; D006801:Humans; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations / Q000379:methods*; D056888:Patient Positioning / Q000379:methods*; D016059:Range of Motion, Articular; D016896:Treatment Outcome