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AAO-HNSF: Oscillation Not Required for Epley Maneuver in Patients with Vertigo By Roberta Friedman Special to DG News SAN DIEGO, CA -- September 25, 2002 -- Vibrating the mastoid is an unnecessary part of the Epley maneuver for vertigo, according to study results reported here Sept. 24th at the 106th annual meeting of the American Academy of Otolaryngology and the Head and Neck Surgery Foundation (AAO-HNSF). Dr. Michael Ruckenstein, an associate professor in the department of otorhinolaryngology, head and neck surgery, University of Pennsylvania, Philadelphia, Pennsylvania, presented a prospective trial of the canalith repositioning approach with and without mastoid oscillation. Patients kept records in a preprinted diary, and their benign positional vertigo was confirmed as involving the posterior semicircular canal, based on the pattern of nystagmus. Each group had 90 patients that were followed closely, with reexamination by two weeks. Dr. Ruckenstein emphasized that the condition has a high spontaneous recovery rate. Final analysis was of 69 patients in the group that received oscillation, and 68 in the group that did not. No significant differences emerged with adding oscillation, with about 70 percent of patients in each group reporting complete resolution of symptoms. Most were better by day 1, with or without vibration of the mastoid. Dr. John Epley, who was in the audience during the presentation, said that he continues to use oscillation ten years after he initially reported it. "In my cases, it accelerates the treatment. I have less early recurrence," Dr. Epley said. Under questioning by Dr. Epley, Dr. Rucklestein withdrew a statement in the meeting abstract, that oscillation might contribute to residual symptoms of lightheadedness and imbalance. He said this was a preliminary speculation not borne out by the completed analysis "I feel a lot better now," Dr. Epley responded. E-mail this page to a friend or colleague! To print, use this version