) was searched for videos that contained a demonstration of the EM. No beginning date cutoff was used, and the last date of the search was August 30, 2011. Search terms were the following: Epley, Epley maneuver, canalith repositioning maneuver, benign paroxysmal positional vertigo, benign positional vertigo, BPPV, and BPV. From the list of results, videos relevant to BPPV were selected for viewing based on their title and the video snapshot provided in the search results list. The search was supplemented by also reviewing the list of featured videos that accompany search results. Videos were eligible if they demonstrated the entire EM. Videos were excluded if they exclusively demonstrated other variants of BPPV treatment (e.g., the Semont maneuver) or the maneuver was considered a substantial deviation from the standard EM (). This study was classified as not regulated research from the institutional review board of the University of Michigan.
The Epley maneuver for right-sided benign paroxysmal positional vertigo (BPPV)
From each video, the date posted, total number of views, duration of the video in seconds, and all comments were abstracted. The videos were categorized as demonstrating guided treatment (i.e., a person guiding the patient through the maneuver) or self-treatment and also as demonstrating an EM for right-sided BPPV, left-sided BPPV, or both. Videos were assessed for content regarding BPPV diagnostic information. Complete diagnostic information was defined as including accurate information about both the symptoms of BPPV (i.e., transient positionally triggered dizziness) and correct identification of the affected side. Videos were also assessed for the inclusion of accurate information about the amount of time each head position of the maneuver should be held (i.e., at least 20 seconds).2
The individual who uploaded each video was classified as a patient, provider, vendor, or unknown based on review of their comments.
To assess how easily the eligible EM videos could be found, searches for the eligible videos were performed using each of the following generic dizziness search terms: dizzy, dizziness, vertigo, positional dizziness, positional vertigo, dizziness treatment, and vertigo treatment. The results were numbered according to the order they were listed by YouTube when using the relevance filter. From each list of results, we then identified the first eligible EM video and recorded its number in the list.
Each video included was independently rated on the accuracy of the EM demonstration by 2 neuro-otologist authors (T.D.F. and R.W.B.). The steps of the EM as described and demonstrated by the practice parameter were used as the criteria for an accurate EM (see for details),2
allowing for minor deviations. Disagreements were resolved by adjudication.
Three authors (K.A.K., L.E.S., and B.C.C.) independently reviewed all posted comments on the YouTube Web site connected with each video and then developed themes (i.e., statements to summarize comment content) regarding the use of the videos. In an effort to reduce the bias that could occur from only neuro-otologist review of the comments, 2 of these authors (L.E.S. and B.C.C.) were selected for this role because they are not neuro-otologists. The individuals submitting the comments pertaining to each video were categorized as patients, patient acquaintances, providers (i.e., medical students, residents, midlevel providers, or physicians), or unknown. The authors then discussed and revised themes until a consensus was reached. Authors also selected examples of comments for each theme.
Data were summarized using proportions, medians with interquartile range, and ranges. The number of hits per day posted was calculated for each video.