Skip to main content

Main menu

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • BJGP LIFE
  • MORE
    • About BJGP
    • Conference
    • Advertising
    • eLetters
    • Alerts
    • Video
    • Audio
    • Librarian information
    • Resilience
    • COVID-19 Clinical Solutions
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers

User menu

  • Subscriptions
  • Alerts
  • Log in

Search

  • Advanced search
British Journal of General Practice
Intended for Healthcare Professionals
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
  • Subscriptions
  • Alerts
  • Log in
  • Follow bjgp on Twitter
  • Visit bjgp on Facebook
  • Blog
  • Listen to BJGP podcast
  • Subscribe BJGP on YouTube
British Journal of General Practice
Intended for Healthcare Professionals

Advanced Search

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • BJGP LIFE
  • MORE
    • About BJGP
    • Conference
    • Advertising
    • eLetters
    • Alerts
    • Video
    • Audio
    • Librarian information
    • Resilience
    • COVID-19 Clinical Solutions
The Back Pages

Can GPs diagnose benign paroxysmal positional vertigo and does the Epley manoeuvre work in primary care?

Sarah Cranfield, Ian Mackenzie and Mark Gabbay
British Journal of General Practice 2010; 60 (578): 698-699. DOI: https://doi.org/10.3399/bjgp10X515557
Sarah Cranfield
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Ian Mackenzie
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Mark Gabbay
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info
  • eLetters
  • PDF
Loading

Benign paroxysmal positional vertigo (BPPV) in adults is a common cause of dizziness seen in general practice with a 1-year prevalence of 1.6%.1 It is characterised by brief episodes of dizziness or vertigo typically triggered by rapid changes in the position of the head and can be associated with nausea which may persist.2 BPPV can resolve spontaneously within weeks or months.2 It can present in clusters and can recur after remission.2 This short paper is based on a critical literature review.

DIAGNOSING BPPV

GPs can confirm a diagnosis of BPPV using the Dix-Hallpike test.2,3 The patient is moved quickly ‘from a sitting position to lying with the head tipped 45° below the horizontal, 45° to the side, and with the side of the affected ear (and semicircular canal) downwards.’2 The Dix-Hallpike test is positive when torsional (rotatory) nystagmus occurs when the head is turned to the affected ear.4 In a prospective study of diagnosis of vertigo in general practice, a positive Dix-Hallpike test had a positive predictive value of 83.3% and a negative predictive value of 52% in diagnosing BPPV.3 Having done so, GPs can then usually resolve the condition through a manipulation called the Epley manoeuvre.

EPLEY MANOEUVRE

The Epley (canalith repositioning) manoeuvre is a ‘safe and effective treatment’ for BPPV.2 It consists of ‘a series of four quick movements of the head and body from sitting to lying, rolling over, and back to sitting (Figure 1). Each position is maintained until positional nystagmus has disappeared, indicating cessation of endolymph flow’.4 The Epley manoeuvre has been shown to be beneficial after one session when 77% of patients reported effective relief and an additional 20% of patients reported the same the following week after the second session.4 Patients are advised to perform self-treatment at home after receiving the Epley manoeuvre.4

Figure 1
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1

The Epley manoeuvre for treating benign paroxysmal positional vertigo. This article was published in Otolaryngology – Head and Neck Surgery, 107(3), Epley JM, The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo, 399–404, Copyright Elsevier 1992.

IS IT FEASIBLE TO IMPLEMENT THE EPLEY MANOEUVRE IN GENERAL PRACTICE?

The Epley manoeuvre in general practice produces similar results when implemented in secondary or tertiary centres.5 A randomised, prospective, double-blind, sham-controlled study determined whether the Epley manoeuvre is effective for treating BPPV in primary care.5 At baseline the intervention group received the Epley manoeuvre and the control group received a sham manoeuvre which consisted of the Epley manoeuvre performed on the unaffected side.5 At 1 week and 2 weeks both groups received the Epley manoeuvre.6 Initial improvement was statistically significant, as after the first treatment 34.2% of patients in the intervention group had a negative Dix-Hallpike test, compared with 14.6% in the control group (P value = 0.04; 95% CI = 1.03 to 5.33).5 This study concluded that the number of patients who were successfully treated with the first Epley manoeuvre was statistically significant compared to the control group, and that GPs could use the Epley manoeuvre to treat BPPV.5

Glasziou suggested that the Epley manoeuvre has been slow to be implemented into primary care because of the level of skill involved and a lack of confidence with the Dix-Hallpike test and the Epley manoeuvre.1 This can be addressed with training; for example, using a video showing the Dix-Hallpike test and Epley manoeuvre.1 It is useful to have another member of staff to assist when carrying out the test and the manoeuvre. The staffing implications need to be considered.

In a 10-minute consultation, a GP could take a history and perform Rinne's and Weber's tests followed by the Dix-Hallpike test and the Epley manoeuvre.

CONCLUSION

The evidence suggests that BPPV can be diagnosed and subsequently treated with the Epley manoeuvre in general practice with great effect, thus reducing referrals to specialist centres. If the patient subsequently presents with unresolved symptoms they should then be referred. Further research needs to be undertaken to measure the effectiveness of the Epley manoeuvre in general practice through further randomised controlled trials. Avoiding long-term medication, and the consequent side effects, is another aspect of the cost-effectiveness of the manoeuvre.

The research evidence suggests this diagnostic manoeuvre and manipulation can be readily and successfully adopted in primary care.

  • © British Journal of General Practice, 2010.

REFERENCES

  1. ↵
    1. Glasziou P,
    2. Heneghan C
    (2008) Epley and the slow boat from research to practice. Evid Based Med 13:34–35.
    OpenUrlFREE Full Text
  2. ↵
    1. Hilton M,
    2. Pinder D
    (2004) The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database Syst Rev 2:CD003162.
  3. ↵
    1. Hanley K,
    2. O’ Dowd T
    (2002) Symptoms of vertigo in general practice: a prospective study of diagnosis. Br J Gen Pract 52:809–812.
    OpenUrlAbstract/FREE Full Text
  4. ↵
    1. Lempert T,
    2. Gresty MA,
    3. Bronstein AM
    (1995) Fortnightly Review: Benign positional vertigo: recognition and treatment. BMJ 311:489–491.
    OpenUrlAbstract/FREE Full Text
  5. ↵
    1. Munoz JE,
    2. Miklea JT,
    3. Howard M,
    4. et al.
    (2007) Canalith repositioning maneuver for benign paroxysmal positional vertigo Randomized controlled trial in family practice. Can Fam Physician 53:1048–1053.
    OpenUrlAbstract/FREE Full Text
Back to top
Previous ArticleNext Article

In this issue

British Journal of General Practice: 60 (578)
British Journal of General Practice
Vol. 60, Issue 578
September 2010
  • Table of Contents
  • Index by author
Download PDF
Download PowerPoint
Article Alerts
Or,
sign in or create an account with your email address
Email Article

Thank you for recommending British Journal of General Practice.

NOTE: We only request your email address so that the person to whom you are recommending the page knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Can GPs diagnose benign paroxysmal positional vertigo and does the Epley manoeuvre work in primary care?
(Your Name) has forwarded a page to you from British Journal of General Practice
(Your Name) thought you would like to see this page from British Journal of General Practice.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Can GPs diagnose benign paroxysmal positional vertigo and does the Epley manoeuvre work in primary care?
Sarah Cranfield, Ian Mackenzie, Mark Gabbay
British Journal of General Practice 2010; 60 (578): 698-699. DOI: 10.3399/bjgp10X515557

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
Can GPs diagnose benign paroxysmal positional vertigo and does the Epley manoeuvre work in primary care?
Sarah Cranfield, Ian Mackenzie, Mark Gabbay
British Journal of General Practice 2010; 60 (578): 698-699. DOI: 10.3399/bjgp10X515557
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
  • Mendeley logo Mendeley

Jump to section

  • Top
  • Article
    • DIAGNOSING BPPV
    • EPLEY MANOEUVRE
    • IS IT FEASIBLE TO IMPLEMENT THE EPLEY MANOEUVRE IN GENERAL PRACTICE?
    • CONCLUSION
    • REFERENCES
  • Figures & Data
  • Info
  • eLetters
  • PDF

More in this TOC Section

The Back Pages

  • How to protect general practice from child protection
  • Who Is My Patient?
  • Working with vulnerable families in deprived areas
Show more The Back Pages

Essay

  • ‘Heartsink’ patients in general practice: a defining paper, its impact, and psychodynamic potential
  • Second thoughts about the NHS reforms
  • Good enough care?
Show more Essay

Related Articles

Cited By...

Intended for Healthcare Professionals

BJGP Life

BJGP Open

 

@BJGPjournal's Likes on Twitter

 
 

British Journal of General Practice

NAVIGATE

  • Home
  • Current Issue
  • All Issues
  • Online First
  • Authors & reviewers

RCGP

  • BJGP for RCGP members
  • BJGP Open
  • RCGP eLearning
  • InnovAiT Journal
  • Jobs and careers

MY ACCOUNT

  • RCGP members' login
  • Subscriber login
  • Activate subscription
  • Terms and conditions

NEWS AND UPDATES

  • About BJGP
  • Alerts
  • RSS feeds
  • Facebook
  • Twitter

AUTHORS & REVIEWERS

  • Submit an article
  • Writing for BJGP: research
  • Writing for BJGP: other sections
  • BJGP editorial process & policies
  • BJGP ethical guidelines
  • Peer review for BJGP

CUSTOMER SERVICES

  • Advertising
  • Contact subscription agent
  • Copyright
  • Librarian information

CONTRIBUTE

  • BJGP Life
  • eLetters
  • Feedback

CONTACT US

BJGP Journal Office
RCGP
30 Euston Square
London NW1 2FB
Tel: +44 (0)20 3188 7400
Email: journal@rcgp.org.uk

British Journal of General Practice is an editorially-independent publication of the Royal College of General Practitioners
© 2023 British Journal of General Practice

Print ISSN: 0960-1643
Online ISSN: 1478-5242