Would the Epley maneuver help a patient who experiences dizziness (vertigo) when closing their eyes, but is stable with eyes open?

Epley Maneuver is Not Appropriate for Dizziness That Occurs Only When Eyes Are Closed

The Epley maneuver would not be appropriate for a patient who experiences dizziness only when closing their eyes but is stable with eyes open, as this symptom pattern is not consistent with benign paroxysmal positional vertigo (BPPV). 1

Understanding the Symptom Pattern

The described symptom pattern (dizziness with eyes closed but stability with eyes open) suggests:

• Possible reliance on visual input for balance (visual dependency)
• Potential central or proprioceptive issue rather than an inner ear problem
• Not characteristic of BPPV, which typically causes brief vertigo with specific head position changes regardless of eye status

Why Epley is Not Appropriate in This Case

The Epley maneuver is specifically designed for posterior canal BPPV, which:

1. Causes brief episodes of vertigo triggered by head position changes 1
2. Is diagnosed by a positive Dix-Hallpike test showing characteristic nystagmus 2
3. Results from displaced otoconia (ear crystals) in the posterior semicircular canal 1

Your patient's symptoms don't match this pattern because:

• Symptoms are triggered by eye closure, not head position changes
• Symptoms are relieved with visual input (eyes open)
• The pattern suggests possible proprioceptive or central vestibular issues

Diagnostic Considerations

Before considering any treatment:

• Perform the Dix-Hallpike maneuver to rule out posterior canal BPPV 1
• If Dix-Hallpike is negative but BPPV is still suspected, perform the supine roll test to assess for horizontal canal BPPV 1
• Consider other causes of dizziness that worsen with eye closure:
  • Central vestibular disorders
  • Proprioceptive deficits
  • Visual dependency syndrome
  • Cervical proprioception issues

More Appropriate Management Approaches

Instead of the Epley maneuver, consider:

1. Vestibular rehabilitation exercises - May help reduce visual dependency and improve central compensation 1, 2
2. Balance training with eyes closed - To reduce reliance on visual input
3. Further vestibular testing - Especially if symptoms persist or worsen 1
4. Neurological evaluation - If central causes are suspected

Common Pitfalls to Avoid

• Performing repositioning maneuvers without confirming BPPV diagnosis with appropriate testing
• Assuming all dizziness is due to BPPV (it accounts for only about 17-42% of vertigo cases) 3
• Missing central or other peripheral vestibular disorders that require different management
• Failing to recognize that BPPV symptoms are typically triggered by position changes, not eye closure

Remember that proper diagnosis is essential before attempting any treatment for vertigo. The Epley maneuver is highly effective for confirmed posterior canal BPPV (61-95% success rate after a single treatment) 2, but inappropriate for other causes of dizziness.