From the Guidelines
The Epley maneuver is helpful for dizziness after a viral upper respiratory infection, but only if the dizziness is specifically caused by benign paroxysmal positional vertigo (BPPV), as evidenced by a 2017 clinical practice guideline that supports the efficacy of the Epley maneuver for BPPV 1.
Key Considerations
- The Epley maneuver works by repositioning displaced calcium crystals in the semicircular canals, potentially relieving vertigo symptoms.
- Viral URIs can sometimes lead to BPPV when viral particles affect the inner ear, displacing these crystals.
- To perform the Epley maneuver, sit on a bed with your head turned 45 degrees to the affected side, quickly lie back with your head hanging slightly off the edge, wait 30 seconds, turn your head 90 degrees to the opposite side, wait another 30 seconds, then roll your body to that side and wait 30 more seconds before slowly sitting up.
Important Distinctions
- Post-viral dizziness may also be caused by vestibular neuritis or labyrinthitis, conditions for which the Epley maneuver is not effective.
- If dizziness persists beyond a few days, is severe, or is accompanied by hearing loss, ear pain, or neurological symptoms, medical evaluation is necessary to determine the exact cause and appropriate treatment.
Evidence-Based Recommendation
- A 2010 meta-analysis found that patients treated with the Epley maneuver had a 6.5-times greater chance of improvement in clinical symptoms relative to controls, as reported in the 2017 guideline 1.
- The 2014 updated Cochrane review included 11 trials and reported that the Epley maneuver is more effective when compared with sham maneuvers or controls, with complete resolution of vertigo occurring significantly more often in the Epley maneuver treatment group 1.
From the Research
Epley Maneuver for Dizziness after Viral Cold
- The Epley maneuver is a treatment for benign paroxysmal positional vertigo (BPPV), which can cause dizziness after a viral upper respiratory infection (URI) 2, 3, 4, 5, 6.
- Studies have shown that the Epley maneuver is effective in treating BPPV, with a significant reduction in vertigo symptoms and conversion of a positive Dix-Hallpike test to a negative test 2, 4, 5.
- The Epley maneuver has been compared to other treatments, such as vestibular rehabilitation, and has been found to be more effective at 1-week follow-up, but equally effective at 1-month follow-up 6.
- The maneuver is generally safe, with no serious adverse effects reported, although some patients may experience nausea or be unable to tolerate the maneuver due to cervical spine problems 4, 5.
Effectiveness of the Epley Maneuver
- A systematic review of 11 randomized controlled trials found that the Epley maneuver was associated with a higher complete resolution of vertigo symptoms and conversion of a positive Dix-Hallpike test to a negative test compared to a sham maneuver or control 4.
- Another study found that the Epley maneuver was more effective than vestibular rehabilitation at 1-week follow-up, with a risk difference of 10-55% 6.
- The number-needed-to-treat for the Epley maneuver has been reported to be as low as 3, indicating that the maneuver is effective in treating BPPV 2.
Limitations and Future Studies
- While the Epley maneuver has been shown to be effective in treating BPPV, further studies are needed to determine its effectiveness in patients with dizziness after a viral URI 2.
- Additionally, studies are needed to investigate the implementation and education of the Epley maneuver in emergency departments and other clinical settings 2.