several published studies and meta-analyses. Updating the Cochrane database, Hilton and Pinder [96] reanalyzed randomized trials of adult patients with p-BPPV to determine the extent of improvement of the vertigo after the Epley maneuver, no treatment, or other repositioning maneuvers. Using only 3 of 15 trials for the final analysis, the authors concluded that there is some evidence that the Epley maneuver is a safe and effective treatment option, but the available data were insufficient to compare the Epley maneuver with other repositioning maneuvers [96]. Another study on the best liberatory maneuver compared the self-applied Semont maneuver with the self-applied Epley procedure. Patients who performed the Epley maneuver had a significantly higher success rate than the group using the Semont maneuver (95 vs. 58%). Thus, the Epley procedure, as a home-based self-applied liberatory maneuver, seems to be the better choice [97].

For h-BPPV, the maneuver involves a 360 horizontal head and body (‘barbecue’) rotation (e.g. rotation about the longitudinal body axis in a supine position) [91].

A small group of patients who were followed for 60 months had a recurrence rate of 26% for posterior canal and 50% for horizontal canal BPPV [98]. Patients with trauma or labyrinthitis had lower initial success rates of the repositioning maneuver, whereas patients with endolymphatic hydrops were predicted to have higher recurrence rates [99, 100].

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A. Straube

Department of Neurology, Klinikum Grosshadern Marchioninistrasse 15

DE–81377 Munich (Germany)

Tel. 49 89 7095 3900, Fax 49 89 7095 3677, E-Mail andreas.straube@med.uni-muenchen.de