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) affecting the posterior semicircular canal, with a significant body of evidence supporting its use, including a 2010 meta-analysis that found patients treated with the Epley maneuver had a 6.5-times greater chance of improvement in clinical symptoms relative to controls 1. To perform the Epley maneuver, the following steps should be taken:

• Sit on a bed with your head turned 45 degrees toward the affected ear
• Quickly lie back with your head hanging slightly off the edge of the bed, maintaining the 45-degree head turn
• 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, with the goal of relieving vertigo symptoms. The Epley maneuver works by using gravity to move displaced calcium carbonate crystals (otoconia) from the semicircular canal back to the utricle where they belong, thus resolving the vertigo, as described in the 2017 clinical practice guideline for BPPV 1. It is essential to note that patients may experience brief dizziness during the maneuver, which is normal, and that the procedure is most commonly performed in the outpatient setting by a clinician after the diagnosis of posterior semicircular canal BPPV has been confirmed 1. Additionally, patients who previously manifested severe nausea and/or vomiting with the Dix-Hallpike maneuver may be offered antiemetic prophylaxis 30 to 60 minutes prior to the Epley maneuver, as recommended in the guideline 1.

From the Research

Epley Maneuver Efficacy

• The Epley maneuver has been shown to be an effective treatment for benign paroxysmal positional vertigo (BPPV) in several studies 2, 3, 4, 5, 6.
• A study published in 2012 found that the Epley maneuver had a success rate of 90.7% after the initial treatment and 96% after the second treatment 2.
• Another study published in 2004 found that the Epley maneuver was more effective than a sham maneuver or control in treating posterior canal BPPV, with a significant reduction in vertigo symptoms and conversion of a positive Dix-Hallpike test to a negative test 3.
• A 1999 study found that the modified Epley maneuver had a success rate of 93.4% in treating BPPV, with an average of 1.23 maneuvers required per patient 4.
• A 2014 Cochrane review found that the Epley maneuver was a safe and effective treatment for posterior canal BPPV, with a significant reduction in vertigo symptoms and conversion of a positive Dix-Hallpike test to a negative test 5.
• A 2022 study found that the Epley maneuver had an efficacy of 90% at 1 week and 100% at 4 weeks in treating posterior semicircular canal BPPV, with significant improvement in the duration and frequency of vertigo attacks and quality of life 6.

Factors Affecting Epley Maneuver Success

• The etiology of BPPV has been found to have a significant effect on the success rate of the Epley maneuver, with idiopathic BPPV showing a higher success rate than secondary BPPV 2.
• The duration of symptoms has been found to have a significant association with the number of sessions required for the Epley maneuver 6.
• Age and gender have not been found to have a significant effect on the success rate of the Epley maneuver 2.

Recurrence and Quality of Life

• Recurrence of BPPV after treatment with the Epley maneuver has been found to be significant, with a recurrence rate of 36% reported in one study 5.
• The Epley maneuver has been found to improve the quality of life of patients with BPPV, with significant improvement in DHI scoring reported in one study 6.