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

NCT ID: NCT07111000

Last Updated: 2025-08-08

Basic Information

• Recruitment Status: NOT_YET_RECRUITING
• Clinical Phase: NA
• Total Enrollment: 118 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-09-01
• Study Completion Date: 2026-08-22

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)

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: DOUBLE

Study Groups

Epley Maneuver

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

Group Type: EXPERIMENTAL

Epley Maneuver

Intervention Type: 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

Sham Maneuver

Group Type: SHAM_COMPARATOR

Sham maneuver

Intervention Type: 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.

Interventions

Epley Maneuver

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

Intervention Type: PROCEDURE

Sham maneuver

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.

Intervention Type: PROCEDURE

Eligibility Criteria

Inclusion Criteria

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

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

American University of Beirut Medical Center

OTHER

Sponsor Role: lead

Responsible Party

Eveline Hitti

Professor of Clinical Specialty

Responsibility Role: PRINCIPAL_INVESTIGATOR

Central Contacts

Eveline Hitti, MD

Role: CONTACT

eh16@aub.edu.lb

00961-1-350000 ext. 6616

Other Identifiers

BIO-2023-0184

Identifier Type: -

Identifier Source: org_study_id