From the Guidelines
The Epley maneuver is a highly effective treatment for benign paroxysmal positional vertigo (BPPV) affecting the posterior semicircular canal, with a success rate of 80-90% in resolving symptoms, as supported by recent studies 1. To perform the Epley maneuver, have the patient sit upright on an examination table with their head turned 45 degrees toward the affected ear. Quickly lay them back with their head hanging slightly off the edge of the table, maintaining the 45-degree rotation. Hold this position for 30 seconds. Then, rotate their head 90 degrees to the opposite side (now 45 degrees toward the unaffected ear) and hold for 30 seconds. Next, have the patient roll their body to the side in the same direction their head is facing, so they're looking at the floor, and hold for 30 seconds. Finally, return them to a sitting position. This sequence repositions displaced calcium carbonate crystals (otoconia) from the semicircular canal back to the utricle where they belong.
Some key points to consider when performing the Epley maneuver include:
- Patients should remain upright for the rest of the day after the procedure to minimize the risk of otoconia falling back into the semicircular canal.
- The maneuver may need to be repeated if symptoms persist, as some patients may require multiple treatments to achieve complete resolution of symptoms.
- Side effects may include nausea, vomiting, or brief worsening of vertigo during the procedure, but these are typically mild and self-limiting.
- The Epley maneuver has been shown to be more effective than other treatments, such as the Brandt-Daroff exercises, in resolving symptoms of BPPV, with a single treatment being more than 10 times more effective than a week of exercises 1.
Overall, the Epley maneuver is a safe and effective treatment for BPPV, with a high success rate and minimal side effects, making it a recommended treatment option for patients with this condition, as supported by recent guidelines 1.
From the Research
Definition and Purpose of the Epley Maneuver
- The Epley maneuver is not mentioned in the provided studies 2, 3, 4, 5, 6.
- The studies focus on the treatment of nasal fractures under local anesthesia and general anesthesia, but do not discuss the Epley maneuver.
Treatment of Nasal Fractures
- The studies discuss the effectiveness of closed reduction of nasal fractures under local anesthesia 2, 3, 6.
- Open reduction and internal fixation of nasal fractures is also discussed, with a medial canthal approach being described as effective in permitting wide exposure and microplate fixation of nasal fractures 4.
- A systematic review and meta-analysis compared local anesthesia and general anesthesia for the management of nasal bone fractures, finding no statistical difference in patient satisfaction with anesthesia, function of the nose, and need for subsequent retreatment, but a statistical difference in patient satisfaction with the appearance of the nose 5.