OBJECTIVE: The aim of this study was to compare watchful waiting to the Epley maneuver as a management option for patients with posterior canal benign paroxysmal positional vertigo (p-BPPV) regarding symptom relief. DATA SOURCES: PubMed, Embase, and the Cochrane Library. METHODS: A systematic search was conducted. Studies reporting original study data were included. Relevance and risk of bias (RoB) of the selected articles were assessed. Studies with low relevance, high RoB, or both were excluded. Absolute risk differences and their 95% confidence intervals (CIs) were extracted for the included studies. RESULTS: A total of 1,448 unique studies were retrieved. Eight of these satisfied the eligibility criteria. At 1-week follow-up, all included studies reported a clinically relevant effect in favor of the Epley maneuver regarding symptom relief (absolute risk differences ranging from 20% (95% CI 5% to 37%) to 59% (95% CI 32% to 76%)) or conversion to a negative Dix-Hallpike (absolute risk differences ranging from 17% (95% CI -5% to 37%) to 64% (95% CI 29% to 79%)). At 1-month follow-up, the results of the included studies diverged further. Absolute risk differences ranged from 6% (95% CI -24% to 35%) more symptom relief in favor of watchful waiting to 79% (95% CI 56% to 88%) in favor of the Epley maneuver. CONCLUSION AND RECOMMENDATIONS: All data of the selected studies show a benefit in favor of the Epley maneuver at 1-week follow-up in the management of p-BPPV. The Epley maneuver should be considered in all patients with p-BPPV.

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