Contortions To Stop The Gyrations

Network meta-analyses are all the rage, vertigo edition.

I will admit: I’m content in my skills at diagnosing a peripheral versus a central cause for vertigo, but – once that’s out of the way, I’ve not much more to rely upon than the handout with the Epley maneuver.

It turns out, there are other options! These include the Gufoni/Appiani, Gans Repositioning, Brandt-Daroff, Semont's, Barbeque Rotation, repeated Dix-Hallpike tests, and variations on the Epley. And, now that we have more options – which one is the best?

That is where this network meta-analysis comes in, attempting to make direct, indirect, and ranked comparisons between these techniques and “usual treatment”. Table 3 gives the Sucra rank comparison and the response rates seen with each treatment:

As you can see, nearly everything is substantially better than "usual treatment” – no surprise there. However, very little data exists for most of these maneuvers, with Epley dominating the evidence base. Some of the other ones may have specific advantages in patients unable to perform the Epley, but it would seem you can’t go wrong with the classic.