Bekir DURMUŞ, Yezdan FIRAT, TÜLAY YILDIRIM, Tayyar KALCIOĞLU, Zuhal ALTAY

Benign paroksismal pozisyonel vertigo tedavisinde semont ve modifiye epley manevralarının etkinliği ve brandt-daroff egzersizlerinin nüksleri önlemedeki etkisi

Amaç: Bu çalışmanın amacı; BPPV'li hastalarda Semont ile Modifiye Epley manevrasının etkinliğini ve manevralardan sonra uygulanan Brandt-Daroff egzersizlerinin tekrarları önleyici etkisi olup olmadığını araştırmaktır. Gereç ve Yöntemler: Çalışmaya, tipik öykü ve Dix-Hallpike testi pozitif olan 17'si erkek, 29'u kadın 46 hasta alındı. Hastalar randomize olarak Semont ve Modifiye Epley Manevrası uygulananlar olmak üzere iki gruba ayrıldılar. Manevralar hastaların iyileşme durumuna göre en fazla üç kez uygulandı. Üçüncü manevradan sonra hastalar iki hafta süre ile Brandt-Daroff egzersizlerini uyguladılar. Hastalar manevradan sonra ve egzersiz uygulamasından sonra vertigonun kaybolması ve Dix-Hallpike testi ile değerlendirildiler. Hastalar 6 ay süre ile nüks açısından takip edildi. Bulgular: Semont manevrası uygulanan grupta birinci, ikinci ve üçüncü manevradan sonraki iyileşme oranları sırasıyla %65,2, %78,2 ve %87 idi. Modifiye Epley manevrası uygulanan grupta ise bu oranlar sırasıyla %73,9, %86,9 ve %91,3 idi. Gruplar arasında istatistiksel olarak anlamlı fark yoktu. Egzersiz sonrası iyileşme oranı Semont grubunda %92,3'e ulaşırken, Modifiye Epley grubunda hastaların tamamı iyileşti. Ancak altı ay sonunda Semont grubunda %19, Modifiye Epley grubunda ise %26,1 oranında vertigonun tekrarladığı görüldü. Sonuç: Semont ve Modifiye Epley manevralarının her ikisinin de BPPV tedavisinde oldukça etkili manevralar olduğu, Brandt-Daroff egzersizlerinin tekrarları önleyici etkisinin olmadığı sonucuna varıldı.

The efficacy of semont and modified epley maneuvers in benign paroxysmal positional vertigo and preventative effect of brandt-daroff exercises on recurrence

Objective: The aim of this study is to investigate the efficacy of Semont and Modified Epley maneuvers in patients with benign paroxismal positional vertigo (BPPV) and the preventative effect of Brandt-Daroff exercises performed after the maneuvers on recurrence of BPPV. Materials and Methods: Fourty-six (17 male and 29 female) patients with a history and positive Dix-Hallpike test consistent with BPPV were entered in the study. Patients were randomly allocated to Semont and Modified Epley maneuvers applied groups. Maneuvers were completed if the patient responded with complete relief of BPPV after one to three sessions. All patients performed Brandt-Daroff vestibular habituation exercises for two weeks after maneuvers. Patients were evaluated with the presence and absence of vertigo and Dix-Hallpike test. For recurrence of BPPV, the patients were followed up for six months. Results: The recovery ratios for Semont maneuver applied group after first, second and third maneuvers were 65,2%, 78,2% and 87% respectively. The ratios for Modified Epley maneuver applied group were 73,9%, 86,9% and 91,3% respectively. There was no statistically significant difference between groups. After exercises, while the recovery ratio for Semont group reached to 92,3%, all of patients in Modified Epley group got recovered. After 6 months, vertigo was recurred in 19% and 26,1% of patients respectively in Semont and Modified Epley groups. Conclusion: It was concluded that both Semont and Modified Epley maneuvers are very effective maneuvers in the treatment of BPPV. Although Brandt-Daroff exercises have no preventative effect on recurrence of BPPV.

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