From the Guidelines
The Epley maneuver should be repeated 2-3 times, with a 30-minute to 1-hour interval between each repetition, if symptoms of benign paroxysmal positional vertigo (BPPV) persist 1.
Key Considerations
- If symptoms resolve after the first or second repetition, no further repetitions are necessary.
- However, if symptoms persist after 3 repetitions, it is advised to wait 24 hours before attempting the maneuver again.
- Patients are often advised to avoid sleeping on the affected side, bending, or heavy lifting for 1-2 days after the procedure to allow the canaliths to settle 1.
Procedure Details
- The patient moves quickly to the right-side lying position, with the head rotated 45 degrees and facing upward, and this position is maintained for 30 seconds after the vertigo stops 1.
- The patient then moves rapidly to a left-side lying position, with the head rotated 45 degrees and facing upward.
- In some cases, patients have repeated these maneuvers three times a day for 2 weeks while hospitalized and had excellent resolution of BPPV symptoms 1.
Important Notes
- Considerable variability exists in terms of the number of times the CRP is applied for the initial treatment of BPPV, and the repeated application of the CRP is likely to be determined by the severity of the symptoms, if they persist; clinician availability; and the clinician’s historical success with the CRP 1.
From the Research
Recommended Frequency for Repeating the Epley Maneuver
The recommended frequency for repeating the Epley maneuver is not strictly defined, but several studies provide insight into the effectiveness of repeated applications:
- A study published in 2014 2 found that the cumulative success percentages of the Epley maneuver ranged from 40% to 100% after the second session, 67% to 98% after the third session, and 87% to 100% after the fourth session.
- Another study from 1999 3 reported that patients received an average of 1.23 Epley maneuvers, with a success rate of 93.4%, and the maneuver was repeated for up to a maximum of three times.
- A 2024 study 4 found that the modified Epley maneuver was successful in 77.3% of patients, and suggested that more than a single maneuver may be required in some resistant patients.
- A 1997 study 5 reported that while 93% of patients improved, many had persistent nystagmus at the first evaluation, and in only 63% was resolution clearly related to a CRP session.
- A 2021 study 6 compared the treatment efficacy of different combinations of the Epley CRM and Dix-Hallpike retest, and found that close repetition of a single Epley CRM after the first effective one would allow a positional retest to be combined with a reduction in the risk of persistent/recurrent BPPV.
Key Findings
- Repeated applications of the Epley maneuver can be beneficial for patients who do not respond to the initial treatment 2, 3, 4.
- The number of repetitions required can vary, but most studies suggest that up to three repetitions may be necessary 2, 3, 6.
- The effectiveness of the Epley maneuver can depend on various factors, including the patient's condition and the technique used 5, 6.