The Efficacy of the Gans Repositioning Maneuver in Comparison with the Epley Maneuver in Elderly Patients with Benign Paroxysmal Positional Vertigo
Abstract
Background and Aim: Benign paroxysmal positional vertigo (BPPV) impacts the quality of life of affected people, especially the elderly. The Epley maneuver and the Gans maneuver are used to treat posterior canal BPPV (PC-BPPV). The effectiveness of the Epley maneuver has been verified, but further studies are required to prove the effectiveness of the Gans maneuver. The main purpose of the current study was to compare the effectiveness of the Gans maneuver with the Epley maneuver in the treatment of the elderly with PC-BPPV, considering emotional, physical, and functional symptoms by assessing anxiety, dizziness, and quality of life after treatment.
Method: Sixty-three elderly patient (74.38±5.34 years) with unilateral PC- BPPV were recruited in this study. They were randomly assigned to two groups. The experimental group received the Gans maneuver, and the control group received the Epley maneuver. All patients completed the Persian version of the Dizziness Handicap Inventory (DHI) and Vestibular Rehabilitation Benefit Questionnaire (VRBQ) before, 48 hours and 1 month after treatment. Recurrence rate was assessed after the 2-month follow up.
Results: Significant differences were observed between pre-treatment and post-treatment questionnaire outcomes for both study groups; nevertheless, in each phase of the study, there were no significant differences between the two groups in the DHI and VRBQ scores.
Conclusion: Both the Gans maneuver and Epley maneuver were almost equally effective and made elderly with PC-BPPV report a better condition in terms of anxiety, emotional factors and quality of life after receiving the maneuvers.
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2. Gans R. Overview of BPPV: treatment methodologies. Hear Rev. 2000;7(9):34-41.
3. Nuti D, Masini M, Mandalà M. Benign paroxysmal positional vertigo and its variants. Handb Clin Neurol. 2016;137:241-56. [DOI:10.1016/B978-0-444-63437-5.00018-2]
4. Caruso G, Nuti D. Epidemiological Data from 2270 PPV Patients. Audiol. Med. 2005;3(1):7-11. [DOI:10.1080/16513860510028310]
5. Nedzelski JM, Barber HO, McIlmoyl L. Diagnoses in a dizziness unit. J Otolaryngol. 1986;15(2):101-4.
6. van der Zaag-Loonen HJ, van Leeuwen RB, Bruintjes TD, van Munster BC. Prevalence of unrecognized benign paroxysmal positional vertigo in older patients. Eur Arch Otorhinolaryngol. 2015;272(6):1521-4. [DOI:10.1007/s00405-014-3409-4]
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11. van Duijn JG, Isfordink LM, Nij Bijvank JA, Stapper CW, van Vuren AJ, Wegner I, et al. Rapid Systematic Review of the Epley Maneuver for Treating Posterior Canal Benign Paroxysmal Positional Vertigo. Otolaryngol Head Neck Surg. 2014;150(6):925-32. [DOI:10.1177/0194599814527732]
12. Imai T, Takeda N, Ikezono T, Shigeno K, Asai M, Watanabe Y, et al. Classification, diagnostic criteria and management of benign paroxysmal positional vertigo. Auris Nasus Larynx. 2017;44(1):1-6. [DOI:10.1016/j.anl.2016.03.013]
13. Pérez-Vázquez P, Franco-Gutiérrez V. Treatment of benign paroxysmal positional vertigo. A clinical review. J Otol. 2017;12(4):165-73. [DOI:10.1016/j.joto.2017.08.004]
14. Amor-Dorado JC, Barreira-Fernández MP, Aran-Gonzalez I, Casariego-Vales E, Llorca J, González-Gay MA. Particle repositioning maneuver versus Brandt-Daroff exercise for treatment of unilateral idiopathic BPPV of the posterior semicircular canal: a randomized prospective clinical trial with short- and long-term outcome. Otol Neurotol. 2012;33(8):1401-7. [DOI:10.1097/MAO.0b013e318268d50a]
15. Teo SP. Semont manoeuvre for vertigo assessment. Aust Fam Physician. 2015;44(7):471-3.
16. Roberts RA, Gans RE, Montaudo RL. Efficacy of a new treatment maneuver for posterior canal benign paroxysmal positional vertigo. J Am Acad Audiol. 2006;17(8):598-604. [DOI:10.3766/jaaa.17.8.6]
17. Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T, et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngol Head Neck Surg. 2017;156(3_suppl):S1-S47.
18. Epley JM. The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 1992;107(3):399-404. [DOI:10.1177/019459989210700310]
19. Herdman SJ, Tusa RJ, Zee DS, Proctor LR, Mattox DE. Single treatment approaches to benign paroxysmal positional vertigo. Arch Otolaryngol Head Neck Surg. 1993;119(4):450-4. [DOI:10.1001/archotol.1993.01880160098015]
20. Bressi F, Vella P, Casale M, Moffa A, Sabatino L, Lopez MA, et al. Vestibular rehabilitation in benign paroxysmal positional vertigo: Reality or fiction? Int J Immunopathol Pharmacol. 2017;30(2):113-22. [DOI:10.1177/0394632017709917]
21. Jafarzadeh S, Bahrami E, Pourbakht A, Jalaie S, Daneshi A. Validity and reliability of the Persian version of the dizziness handicap inventory. J Res Med Sci. 2014;19(8):769-75.
22. Moossavi A, Mehrkian S, Hamzehpour F, Bakhshi E. Development and assessment of validity and reliability of the Persian version of vestibular rehabilitation benefit questionnaire. Aud Vestib Res. 2018;27(2):65-71.
23. Dispenza F, Kulamarva G, De Stefano A. Comparison of repositioning maneuvers for benign paroxysmal positional vertigo of posterior semicircular canal: advantages of hybrid maneuver. Am J Otolaryngol. 2012;33(5):528-32. [DOI:10.1016/j.amjoto.2011.12.002]
24. Badawy WM, Gad El-Mawla EK, Chedid AE, Mustafa AH. Effect of a hybrid maneuver in treating posterior canal benign paroxysmal positional vertigo. J Am Acad Audiol. 2015;26(2):138-44. [DOI:10.3766/jaaa.26.2.4]
25. Saberi A, Nemati S, Sabnan S, Mollahoseini F, Kazemnejad E. A safe-repositioning maneuver for the management of benign paroxysmal positional vertigo: Gans vs. Epley maneuver; a randomized comparative clinical trial. Eur Arch Otorhinolaryngol. 2017;274(8):2973-9. [DOI:10.1007/s00405-016-4235-7]
26. Omara A, Mosaad DM, Mohamed AS, Abd El-Raoof NA. Epley repositioning maneuver versus Gans repositioning maneuver on postural instability in elderly patients with benign paroxysmal positional vertigo. Egypt J Otolaryngol. 2017;33:518-22. [DOI:10.4103/1012-5574.206025]
27. Gayathri H, Preethi GR, Christina PM. Outcome of Gans Repositioning Maneuver in Patients with Posterior Canal Benign Paroxysmal Positional Vertigo with Cervical Spondylosis. Indian J Otolaryngol. 2019;25(4):196-200. [DOI:10.4103/indianjotol.INDIANJOTOL_62_19]
28. Dhiman NR, Joshi D, Gyanpuri V, Pathak A, Kumar A. Comparison between Epley and Gans Repositioning Maneuvers for Posterior Canal BPPV: A Randomized Controlled Trial. Ann Indian Acad Neurol. 2023;26(4):537-42. [DOI:10.4103/aian.aian_12_23]
2. Gans R. Overview of BPPV: treatment methodologies. Hear Rev. 2000;7(9):34-41.
3. Nuti D, Masini M, Mandalà M. Benign paroxysmal positional vertigo and its variants. Handb Clin Neurol. 2016;137:241-56. [DOI:10.1016/B978-0-444-63437-5.00018-2]
4. Caruso G, Nuti D. Epidemiological Data from 2270 PPV Patients. Audiol. Med. 2005;3(1):7-11. [DOI:10.1080/16513860510028310]
5. Nedzelski JM, Barber HO, McIlmoyl L. Diagnoses in a dizziness unit. J Otolaryngol. 1986;15(2):101-4.
6. van der Zaag-Loonen HJ, van Leeuwen RB, Bruintjes TD, van Munster BC. Prevalence of unrecognized benign paroxysmal positional vertigo in older patients. Eur Arch Otorhinolaryngol. 2015;272(6):1521-4. [DOI:10.1007/s00405-014-3409-4]
7. Helminski JO, Zee DS, Janssen I, Hain TC. Effectiveness of particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo: a systematic review. Phys Ther. 2010;90(5):663-78. [DOI:10.2522/ptj.20090071]
8. Jilla AM, Roberts RA, Johnson CE. Teaching Patient-Centered Counseling Skills for Assessment, Diagnosis, and Management of Benign Paroxysmal Positional Vertigo. Semin Hear. 2018;39(1):52-66. [DOI:10.1055/s-0037-1613705]
9. Lopez-Escamez JA, Gamiz MJ, Fernandez-Perez A, Gomez-Fiñana M. Long-term outcome and health-related quality of life in benign paroxysmal positional vertigo. Eur Arch Otorhinolaryngol. 2005;262(6):507-11. [DOI:10.1007/s00405-004-0841-x]
10. Roberts RA, Abrams H, Sembach MK, Lister JJ, Gans RE, Chisolm TH. Utility measures of health-related quality of life in patients treated for benign paroxysmal positional vertigo. Ear Hear. 2009;30(3):369-76. [DOI:10.1097/AUD.0b013e31819f316a]
11. van Duijn JG, Isfordink LM, Nij Bijvank JA, Stapper CW, van Vuren AJ, Wegner I, et al. Rapid Systematic Review of the Epley Maneuver for Treating Posterior Canal Benign Paroxysmal Positional Vertigo. Otolaryngol Head Neck Surg. 2014;150(6):925-32. [DOI:10.1177/0194599814527732]
12. Imai T, Takeda N, Ikezono T, Shigeno K, Asai M, Watanabe Y, et al. Classification, diagnostic criteria and management of benign paroxysmal positional vertigo. Auris Nasus Larynx. 2017;44(1):1-6. [DOI:10.1016/j.anl.2016.03.013]
13. Pérez-Vázquez P, Franco-Gutiérrez V. Treatment of benign paroxysmal positional vertigo. A clinical review. J Otol. 2017;12(4):165-73. [DOI:10.1016/j.joto.2017.08.004]
14. Amor-Dorado JC, Barreira-Fernández MP, Aran-Gonzalez I, Casariego-Vales E, Llorca J, González-Gay MA. Particle repositioning maneuver versus Brandt-Daroff exercise for treatment of unilateral idiopathic BPPV of the posterior semicircular canal: a randomized prospective clinical trial with short- and long-term outcome. Otol Neurotol. 2012;33(8):1401-7. [DOI:10.1097/MAO.0b013e318268d50a]
15. Teo SP. Semont manoeuvre for vertigo assessment. Aust Fam Physician. 2015;44(7):471-3.
16. Roberts RA, Gans RE, Montaudo RL. Efficacy of a new treatment maneuver for posterior canal benign paroxysmal positional vertigo. J Am Acad Audiol. 2006;17(8):598-604. [DOI:10.3766/jaaa.17.8.6]
17. Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T, et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngol Head Neck Surg. 2017;156(3_suppl):S1-S47.
18. Epley JM. The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 1992;107(3):399-404. [DOI:10.1177/019459989210700310]
19. Herdman SJ, Tusa RJ, Zee DS, Proctor LR, Mattox DE. Single treatment approaches to benign paroxysmal positional vertigo. Arch Otolaryngol Head Neck Surg. 1993;119(4):450-4. [DOI:10.1001/archotol.1993.01880160098015]
20. Bressi F, Vella P, Casale M, Moffa A, Sabatino L, Lopez MA, et al. Vestibular rehabilitation in benign paroxysmal positional vertigo: Reality or fiction? Int J Immunopathol Pharmacol. 2017;30(2):113-22. [DOI:10.1177/0394632017709917]
21. Jafarzadeh S, Bahrami E, Pourbakht A, Jalaie S, Daneshi A. Validity and reliability of the Persian version of the dizziness handicap inventory. J Res Med Sci. 2014;19(8):769-75.
22. Moossavi A, Mehrkian S, Hamzehpour F, Bakhshi E. Development and assessment of validity and reliability of the Persian version of vestibular rehabilitation benefit questionnaire. Aud Vestib Res. 2018;27(2):65-71.
23. Dispenza F, Kulamarva G, De Stefano A. Comparison of repositioning maneuvers for benign paroxysmal positional vertigo of posterior semicircular canal: advantages of hybrid maneuver. Am J Otolaryngol. 2012;33(5):528-32. [DOI:10.1016/j.amjoto.2011.12.002]
24. Badawy WM, Gad El-Mawla EK, Chedid AE, Mustafa AH. Effect of a hybrid maneuver in treating posterior canal benign paroxysmal positional vertigo. J Am Acad Audiol. 2015;26(2):138-44. [DOI:10.3766/jaaa.26.2.4]
25. Saberi A, Nemati S, Sabnan S, Mollahoseini F, Kazemnejad E. A safe-repositioning maneuver for the management of benign paroxysmal positional vertigo: Gans vs. Epley maneuver; a randomized comparative clinical trial. Eur Arch Otorhinolaryngol. 2017;274(8):2973-9. [DOI:10.1007/s00405-016-4235-7]
26. Omara A, Mosaad DM, Mohamed AS, Abd El-Raoof NA. Epley repositioning maneuver versus Gans repositioning maneuver on postural instability in elderly patients with benign paroxysmal positional vertigo. Egypt J Otolaryngol. 2017;33:518-22. [DOI:10.4103/1012-5574.206025]
27. Gayathri H, Preethi GR, Christina PM. Outcome of Gans Repositioning Maneuver in Patients with Posterior Canal Benign Paroxysmal Positional Vertigo with Cervical Spondylosis. Indian J Otolaryngol. 2019;25(4):196-200. [DOI:10.4103/indianjotol.INDIANJOTOL_62_19]
28. Dhiman NR, Joshi D, Gyanpuri V, Pathak A, Kumar A. Comparison between Epley and Gans Repositioning Maneuvers for Posterior Canal BPPV: A Randomized Controlled Trial. Ann Indian Acad Neurol. 2023;26(4):537-42. [DOI:10.4103/aian.aian_12_23]
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How to Cite
1.
Fazelifard A, Ashrafi M. The Efficacy of the Gans Repositioning Maneuver in Comparison with the Epley Maneuver in Elderly Patients with Benign Paroxysmal Positional Vertigo. Aud Vestib Res. 2024;.
