International Journal For Multidisciplinary Research

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Effectiveness of epley’s maneuver on dizziness, dynamic balance and quality of life in individuals with benign paroxysmal positional vertigo (bppv) - case series

Author(s) Ms. Giri Priya, Dr. vadlamudi srikumari, Dr. gaali kameswari
Country India
Abstract Background:
Benign paroxysmal positional vertigo (BPPV) is the most prevalent peripheral vestibular disorder, characterized by transient episodes of vertigo triggered by changes in head position relative to gravity (1). Though often underdiagnosed, BPPV significantly impacts quality of life and functional independence. Epley’s maneuver, a canalith repositioning procedure, is widely accepted as a first-line treatment, especially for posterior canal BPPV (6). However, limited case series have been documented on validated clinical scales like the Dizziness Handicap Inventory (DHI), Dynamic Gait Index (DGI), and Vestibular Activities of Daily Living (VADL) in individuals with BPPV.
Objective:
To evaluate the effectiveness of Epley’s maneuver in improving dizziness, dynamic balance, and quality of life in patients diagnosed with BPPV using Dizziness Handicap Inventory (DHI), Dynamic Gait Index (DGI), and Vestibular Activities of Daily Living (VADL).
Methodology:
This case series comprised four patients diagnosed with BPPV through clinical examination and positional tests, including the Dix-Hall pike, supine roll tests and characteristic nystagmus patterns. Informed consents were obtained from all the patients. Epley’s maneuver was administered twice weekly, with each position held for 30 seconds over a 15-minute session. All patients were educated on and prescribed Brandt-Daroff exercises as a home program (5 cycles per set, 3 sets per day). DHI, DGI, and VADL scores were assessed at baseline and post treatment.
Results:
All four patients showed a substantial reduction in dizziness and functional impairment, along with an improvement in dynamic balance. Case 1: A 32-year-old female with left posterior canal BPPV showed a DHI reduction from 82 to 32, DGI improvement from 15 to 22, and VADL from 114 to 36 by week 8. Case 2: A 45-year-old male with left posterior canal BPPV had marked early improvement with DHI dropping from 45 to 10, DGI increasing from 8 to 23, and VADL improving from 45 to 36 in just one week. Case 3: A 54-year-old female with multi-canal BPPV demonstrated steady improvements from baseline (DHI 96, DGI 8, VADL 143) to week 3 (DHI 68, DGI 20, VADL 73). Case 4: A 31-year-old female with right posterior canal BPPV showed significant improvement by week 8, with DHI improving from an estimated moderate score to 25, DGI from 13 to 23, and VADL from 54 to 36. No adverse effects were reported, and positional tests showed reduction in nystagmus.
Conclusion:
Epley’s maneuver is highly effective in managing posterior and multi-canal BPPV, resulting in rapid and measurable improvements in dizziness, balance, and daily functioning. When combined with patient education and home-based Brandt-Daroff exercises, this protocol offers a safe, cost-effective, and accessible treatment strategy. Systematic use of clinical scales like DHI, DGI, and VADL enhances outcome monitoring and supports patient-centered care in vestibular rehabilitation.
Clinical implication:
For selection of appropriate treatment technique, it is essential to observe and identify the onset, direction, duration, latency; fatigability of nystagmus also plays an important role. Application of unsupervised Brandt-Daroff exercises as a home exercise program is found to be beneficial in all the 4 patients that showed the symptoms of BPPV and thus prevent the recurrence.
Keywords Benign Paroxysmal Positional Vertigo (BPPV), Epley’s Maneuver, Dizziness Handicap Inventory (DHI), Dynamic Gait Index (DGI), Vestibular Activities of Daily Living (VADL), case series, vestibular rehabilitation.
Published In Volume 7, Issue 5, September-October 2025
Published On 2025-09-05
DOI https://doi.org/10.36948/ijfmr.2025.v07i05.55221
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