What is the Epley maneuver (Canalith Repositioning Procedure)?

From the Guidelines

The Epley maneuver is a highly effective treatment for benign paroxysmal positional vertigo (BPPV) and should be performed by a healthcare provider or taught to patients for home use, as it has been shown to be more effective than sham maneuvers or controls, with a significant improvement in clinical symptoms and conversion to a negative Dix-Hallpike maneuver 1. To perform the Epley maneuver, the following steps should be taken:

• Start by sitting upright on a bed or examination table with your head turned 45 degrees toward the affected ear.
• Quickly lie back with your head hanging slightly off the edge of the surface, maintaining the 45-degree head turn, and hold this position for 30 seconds or until dizziness subsides.
• Then, without sitting up, turn your head 90 degrees to the opposite side and hold for another 30 seconds.
• Next, roll your body to the side in the same direction your head is facing, so you're looking at the floor, and hold for 30 seconds.
• Finally, slowly return to a sitting position. The entire procedure should be repeated as necessary, and patients should be informed that nausea, occasional vomiting, and/or a sense of falling may arise during the procedure, and antiemetic prophylaxis may be offered 30 to 60 minutes prior to the maneuver if necessary 1. The Epley maneuver works by using gravity to move displaced calcium carbonate crystals (otoconia) from the semicircular canals back to the utricle where they belong, thus resolving the abnormal stimulation that causes vertigo, and it has been shown to be more effective than other treatments, such as the Brandt-Daroff exercises, with a single maneuver being more than 10 times more effective than a week of exercises 1.

From the Research

Epley Maneuver Overview

• The Epley maneuver is a treatment for benign paroxysmal positional vertigo (BPPV), a syndrome characterized by short-lived episodes of vertigo in association with rapid changes in head position 2, 3.
• It is a physical maneuver that relocates displaced free-floating otoconia in the semicircular canals into the utricle, thereby relieving vertigo symptoms 4.

Efficacy of the Epley Maneuver

• Studies have shown that the Epley maneuver is a safe and effective treatment for posterior canal BPPV, with a significant reduction in vertigo symptoms and improvement in quality of life 5, 3, 4, 6.
• The maneuver has been shown to have a high success rate, with one study reporting a 93.4% success rate after an average of 1.23 maneuvers per patient 5.
• Another study found that the Epley maneuver had a 90% efficacy rate at 1 week and a 100% efficacy rate at 4 weeks, with significant improvement in the duration and frequency of vertigo attacks 4.

Comparison with Other Treatments

• The Epley maneuver has been compared to other treatments, including sham maneuvers, other particle repositioning maneuvers (such as the Semont and Gans maneuvers), and control groups 2, 3, 6.
• Studies have shown that the Epley maneuver is more effective than sham maneuvers and control groups in resolving vertigo symptoms and converting a positive Dix-Hallpike test to a negative test 2, 3, 6.
• The Epley maneuver has also been shown to be comparable to other particle repositioning maneuvers, such as the Semont and Gans maneuvers, in terms of efficacy 3.

Adverse Effects and Recurrence

• The Epley maneuver has been shown to be safe, with no serious adverse effects reported in the studies reviewed 2, 3, 6.
• However, some patients may experience nausea or discomfort during the maneuver, and some may not be able to tolerate the maneuver due to cervical spine problems 3.
• Recurrence of BPPV after treatment with the Epley maneuver has been reported, with one study finding a recurrence rate of 36% 3 and another study finding a recurrence rate of 10% at 6 months follow-up 4.