Postural crisis in patients undergoing canalith repositioning procedures for posterior canal benign paroxysmal positional vertigo: A systematic review and meta-analysis

Background: The Epley or Semont maneuver is performed for posterior canal benign paroxysmal positional vertigo (PC-BPPV). The postural crisis indicates the phenomenon that the patient experiences severe dizziness, is unable to maintain the sitting posture, and suddenly falls backward or sideways on the examination table when returning to the sitting position, which is the final step of the canalith repositioning procedure (CRP). The postural crisis increases the risk of falls during CRP. This meta-analysis aimed to determine the incidence of postural crisis among patients who underwent CRP for PC-BPPV.

Methods: Literature searches were conducted on PubMed, Embase, Cochrane Library, Web of Science, and Google Scholar. The random-effects model was utilized based on the results of the heterogeneity using the Tau2 test and I2 statistic.

Results: We included 5 nonrandomized studies that reported the total number of cases of CRP for PC-BPPV and postural crisis. In each study, postural crisis occurred in 4.0% to 14.9% of the subjects. Of a total of 1177 cases, the incidence of postural crisis in all CRP cases was 10% (95% confidence interval = 6%-15%).

Conclusion: BPPV is the most common among peripheral vestibular diseases, usually occurring in the posterior semicircular canal. Therefore, 10% of cases with CRP for PC-BPPV is significant. When performing CRP for PC-BPPV, considering that the postural crisis related to increasing the risk of falls may occur, preparations for the phenomenon should be made in advance.