Efficacy of Epley Maneuver on Quality of Life of Elderly Patients with Subjective BPPV

Dear Editor,

I have read with great interest the article titled “Efficacy of Epley Maneuver on Quality of Life of Elderly Patients with Subjective BPPV” in the December 2019 issue of The Journal of International Advanced Otology (15(3): 420–4) by Uzdan Uz et al ^[1]. However, I do not agree with some of the suggestions included, and some points are unclear.

The authors defined their treatment group as patients treated with Epley maneuver bilaterally. I do not agree with this treatment. Balatsouras et al. ^[2] described the criteria for diagnosis of subjective BPPV as (1) history of repeated brief episodes of vertigo with changes in head position; (2) vertigo provoked by the Dix-Hallpike or the supine roll test; (3) absence of any detectable nystagmus by naked-eye examination during and after the provoking maneuvers; (4) duration of the disease for at least 1 month with no signs of recent improvement; and (5) absence of evidence of any other vestibular disease. They observed that the vertigo was unilaterally or bilaterally provoked during the Dix-Hallpike test or the supine rolling test, which means involvement of the associated canal. Subsequently, for the treatment, a repositioning maneuver was performed for the relevant channel ^[2]. Also Jung and Kim ^[3] explained in their study that the patients were treated using repositioning maneuver appropriate for their type of BPPV and associated canal.

I believe that the affected side should be determined with the Dix-Hallpike test (the authors declared that all the patients underwent the bilateral supine roll test to exclude horizontal canal BPPV) and then Epley maneuver should be performed to the affected side. If vertigo could not provoked by the Dix-Hallpike test, the authors must reconsider the diagnosis or repeat the Dix-Hallpike maneuver.