Efficacy Analysis Of Modified Epley Maneuver In Elderly Idiopathic BPPV Patients With Limited Neck Movement

Objective:To evaluate the efficacy of the modified Epley maneuver in the reduction of elderly idiopathic BPPV patients with limited neck movement.Methods: Selected 53 elderly idiopathic BPPV with limited neck movement BPPV patients who met the inclusion and exclusion criteria in the Otorhinolaryngology Head and Neck Surgery Clinic of the First Affiliated Hospital of Xiamen University from January 2010 to June 2020.The main complaint of the patient was dizziness,vertigo,falling,instability,etc.Neck range of motion was measured in all patients before treatment.All the treatments were performed by the same doctor.The diagnosis and treatment of the horizontal semicircular canal otolith were performed by the classic rolling test and Barbecue method.The diagnosis of otoliths in the posterior semicircular canal adopts the modified Dix Hallpike test,and the treatment adopts the modified Epley maneuver.Patients were advised to return to the clinic one week after the first reduction.Those with typical vertigo and nystagmus should be treated again,and the patient’s recovery was evaluated.All patients underwent brain imaging(CT/MRI)to rule out the presence or absence of cerebral infarction.The follow-up time nodes after treatment were the first reduction,1 week and 6 months.All patients were assessed with Dizziness Handicap Inventory(DHI)before and one week after treatment.SPSS23.0 software was used for statistical analysis,and P<0.05 was considered statistically significant.Results: A total of 53 elderly idiopathic BPPV with limited neck movement BPPV patients met the inclusion criteria and exclusion criteria,including 15 males and 38 females.The median duration of medical history was 45 days.There were 11 cases of BPPV in horizontal semicircular canal,30 cases of BPPV in posterior semicircular canal,6 cases of BPPV in superior semicircular canal,and 6 cases of multi-canal.BPPV was located on the left side in 18 cases and on the right side in 35 cases.There were 27 patients complicated with hypertension and 23 patients complicated with diabetes.Eleven patients changed from single otolith to multiple otolith after initial reduction.Thirty patients had residual dizziness after reduction.The brain imaging of all patients did not suggest a complication of cerebral infarction.After the initial reduction,42 patients were cured,11 patients still had vertigo and/or nystagmus,and the initial cure rate was 79.2%.The patients were asked to return to the clinic one week later.No vertigo and nystagmus were induced in 34 patients during the postural test,but 19 patients were still positive in the postural test,and the short-term recurrence rate was 35.8%.38 patients did not relapse for half a year,and 15 patients went to the doctor again for BPPV after half a year,with a long-term recurrence rate of 28.3%.After treatment,all patients had no side injuries of neck discomfort or neck pain.Univariate analysis was used to explore the influence of gender,occurrence side,hypertension and diabetes on the long-term recurrence of elderly patients with BPPV,and there was no statistical difference in the results(P >0.05).However,the total score of DHI after treatment was significantly lower than that before treatment(P < 0.05).Conclusions: The modified Epley technique was used for the first time in elderly idiopathic BPPV patients with limited neck movement,and achieved good results without side injury.