What are the steps for performing the Epley maneuver for benign paroxysmal positional vertigo (BPPV)?

From the Guidelines

The Epley maneuver is an effective treatment for benign paroxysmal positional vertigo (BPPV) affecting the posterior semicircular canal, and can be performed in the following steps. First, have the patient sit upright on an examination table with their legs extended and head turned 45 degrees toward the affected ear. Next, quickly help the patient lie back so their head hangs slightly over the edge of the table, maintaining the 45-degree rotation, and hold this position for 30 seconds or until vertigo subsides. Then, without raising the patient's head, turn it 90 degrees in the opposite direction (now 45 degrees toward the unaffected ear) and hold for another 30 seconds. Following this, have the patient roll their shoulders and body to the same side as their head is facing, maintaining head position relative to the shoulders, and hold for 30 seconds. Finally, have the patient slowly return to a sitting position while keeping their head turned 45 degrees to the unaffected side. The entire procedure works by using gravity to move displaced calcium carbonate crystals (otoconia) from the semicircular canal back into the utricle where they belong. After the procedure, patients should remain upright for the rest of the day and avoid sudden head movements. The maneuver may need to be repeated multiple times for complete resolution of symptoms, and some patients may experience brief vertigo during the procedure as the crystals move through the canals, as supported by the clinical practice guideline: benign paroxysmal positional vertigo (update) 1.

Some key points to consider when performing the Epley maneuver include:

• The patient should be seated upright on an examination table with their legs extended and head turned 45 degrees toward the affected ear.
• The patient's head should be quickly moved to the supine position with their head hanging slightly over the edge of the table, maintaining the 45-degree rotation.
• The patient's head should be turned 90 degrees in the opposite direction and held for another 30 seconds.
• The patient should roll their shoulders and body to the same side as their head is facing, maintaining head position relative to the shoulders, and hold for 30 seconds.
• The patient should slowly return to a sitting position while keeping their head turned 45 degrees to the unaffected side.

It is also important to note that the Epley maneuver is not suitable for all patients, particularly those with certain medical conditions such as cervical spine disease, retinal detachment, or spinal cord injuries, as highlighted in the clinical practice guideline: benign paroxysmal positional vertigo (update) 1.

In addition, patients should be educated on the potential risks and benefits of the Epley maneuver, including the possibility of brief vertigo during the procedure and the importance of remaining upright after the procedure, as discussed in the patient information: frequently asked questions section of the clinical practice guideline: benign paroxysmal positional vertigo (update) 1.

Overall, the Epley maneuver is a safe and effective treatment for BPPV, and can be performed in a clinical setting with proper training and equipment, as supported by the clinical practice guideline: benign paroxysmal positional vertigo (update) 1.

From the Research

Epley Maneuver Instructions

The Epley maneuver is a series of movements used to treat benign paroxysmal positional vertigo (BPPV) by relocating the otoconia in the semicircular canals of the inner ear. The steps for performing the Epley maneuver are as follows:

• Sit on a bed or table with the affected ear facing upwards
• Turn the head to the affected side at a 45-degree angle
• Lie down quickly with the affected ear facing downwards, keeping the head turned to the affected side
• Stay in this position for 1-2 minutes
• Slowly sit up and turn the head to the unaffected side
• Repeat the process 2-3 times

Efficacy of the Epley Maneuver

Studies have shown that the Epley maneuver is an effective treatment for BPPV, with a high success rate in resolving vertigo symptoms 2, 3, 4. The maneuver has been shown to be safe and effective in treating posterior semicircular canal BPPV, with a low risk of adverse effects 3, 5.

Comparison with Other Treatments

The Epley maneuver has been compared to other treatments for BPPV, including the Semont maneuver, Brandt-Daroff exercises, and Cawthorne-Cooksey vestibular exercises. Studies have shown that the Epley maneuver is as effective as, or more effective than, these other treatments in resolving vertigo symptoms 3, 6.

Key Points

• The Epley maneuver is a series of movements used to treat BPPV by relocating the otoconia in the semicircular canals of the inner ear
• The maneuver is safe and effective in treating posterior semicircular canal BPPV, with a low risk of adverse effects
• The Epley maneuver has been shown to be as effective as, or more effective than, other treatments for BPPV, including the Semont maneuver, Brandt-Daroff exercises, and Cawthorne-Cooksey vestibular exercises 2, 3, 4, 6, 5