The use of the Epley Omniax device in the treatment of Benign Paroxysmal Positional Vertigo (BPPV)

This study will be a randomised controlled trial (RCT) comparing two treatment conditions on the Epley Omniax System (EOS) a mechanical treatment system by Vesticon for the treatment of Benign Paroxysmal Positional Vertigo (BPPV). The EOS is a combined motorized positioning and real time infra-red videooculography system. It consists of a chair with a five-point harness incorporated into a two-axis rotator that allows 360-degree movement of the whole patient in any direction. Oculomotor characteristics are recorded using the systems infrared video oculography goggles, which have the capture rate of 30 Hz and allow the removal of visual fixation.This treatment trial will be for the treatment of posterior canal (PC) BPPV using either the mechanical Epley, or Somersault manoeuvres on the EOS as described below. Any nystagmus elicited will be recorded using infra-red video-nystagmography (VNG) (1) Epley manoeuvre: * with patients in the seated position, they are rotated to 45 degrees to the affected side, before being tilted to 120 degrees down, awaiting the elicitation of nystagmus and vertigo as per the usual dix-hallpike position. They are then rotated to 90 degrees to opposite side, rolled over and sat up, similar to the bedside Epley manoeuvre. (2) Somersault manoeuvre: * With patients in the seated position, they will undergo a 360 degree reverse somersault. Patients will be randomised into one of two treatment groups. There will be no control group in this study, as current clinical guidelines recommend the treatment of BPPV and therefore withholding treatment would be a breach of ethical guidelines regarding ‘best practice’. Patients will undergo a maximum of 4 clinical treatments in their specified treatment group (i.e. until they display a negative Dix-Hallpike (DHP) test (defined as an absence of PC BPPV nystagmus on repeat DHP testing). The number of treatments per clinical session will be determined by patient tolerance i.e. the presence of nausea or severity of symptoms, and response to treatment, i.e. the presence or absence of nystagmus. This will be used to monitor fidelity of intervention and will be documented in the clinicians notes by either a Physiotherapist or Audiologist administering the intervention. Initial consultations are 45 minutes and follow up consultations are 30 minutes. The number of clinical sessions depends on whether the BPPV resolves, based on previous studies, this is typically within 4 or less treatment manoeuvres or 2 or less sessions. Alternate treatment manoeuvres will be completed either within the same session or the following session depending on patient tolerance. Treatment sessions will be once per week until the BPPV resolves. Should patients experience nausea, they will be appropriately managed with antiemetic medications such as stemetil or ondansetron as required, as prescribed by an accompanying Oto-neurologist. Should patients continue to display nystagmus consistent with BPPV after 4 clinical treatments in their selected treatment group, the treatment will be deemed unsuccessful and the patient with be offered the alternate manoeuvre to ensure effective and appropriate clinical care. Should patients experience canal conversion i.e. to horizontal canal BPPV, results will be documented and recorded, and patients will be treated with the alternate treatment manoeuvre as appropriate i.e. Barbeque roll for horizontal canal BPPV. In our earlier study (Power, 2018) patients with PC BPPV, 94% (n = 74/79) experienced relief after three manoeuvres, hence it is anticipated the majority of patients will be effectively treated in 4 or less manoeuvres. These patient treatment procedures do not vary from standard clinic procedures, except for the random allocation to one of two treatment groups. Power, L., Murray, K., Szmulewicz, D. (2018) Early Experience with a multi-axial, whole body positioning system in the treatment of Benign Paroxysmal Positional Vertigo (BPPV). Journal of Clinical Neuroscience. 61; 186 - 188