THE EFFECTIVENESS OF THE EPLEY MANEUVER FOR BENIGN PAROXYSMAL POSITIONAL VERTIGO: A META-ANALYSIS

Benign paroxysmal positional vertigo (BPPV) is a leading cause of episodic vertigo, yet uncertainty persists regarding
the magnitude and durability of benefit from the Epley canalith repositioning maneuver across clinical settings. We
conducted a PRISMA 2020–guided systematic review and meta-analysis of randomized and non-randomized
controlled studies and prospective clinical series that enrolled adolescents or adults with posterior-canal BPPV and
evaluated the Epley maneuver delivered as a single or repeated/protocolized intervention. Primary outcomes were
symptom resolution or conversion to a negative Dix–Hallpike test; secondary outcomes included recurrence and
adverse events. Eighteen studies met the inclusion criteria, the majority randomized or controlled. Across trials, the
Epley maneuver produced substantially higher early resolution rates than sham, no treatment, or medication alone,
with success commonly approaching 80–85% when repeat sessions were permitted. Comparisons with alternative
maneuvers suggested broadly similar or modestly higher effectiveness and faster relief with Epley. Recurrence rates
during follow-up were generally low, most often in the 10–15% range, and reported adverse events were infrequent
and transient. Overall, the Epley maneuver appears to be a rapid, effective, and safe first-line treatment for posteriorcanal BPPV and should be widely implemented and protocolized in emergency, primary care, and specialty practice.