From the Guidelines
The Epley maneuver, also known as the Canalith Repositioning Procedure, should be performed by starting with the patient sitting on a bed, then quickly moving to a right-side lying position with the head rotated 45 degrees and facing upward, holding for 30 seconds after the vertigo stops, then rapidly moving to a left-side lying position with the head rotated 45 degrees and facing upward, as described in the clinical practice guideline by 1. The procedure is designed to treat benign paroxysmal positional vertigo (BPPV) by repositioning calcium crystals in the inner ear.
- The patient should start by sitting on a bed with their head turned 45 degrees toward the affected ear.
- They should then quickly lie back with their head hanging slightly off the edge of the bed, maintaining the 45-degree turn, and hold this position for 30 seconds or until dizziness subsides.
- Next, they should turn their head 90 degrees to the opposite side without raising it, and hold for another 30 seconds.
- Then, they should roll their body to that same side so they're looking at the floor, and hold for 30 seconds.
- Finally, they should slowly return to a sitting position and remain upright for at least 15 minutes. The maneuver works by using gravity to move displaced calcium carbonate crystals from the semicircular canals back to the utricle where they belong, resolving the vertigo symptoms, as supported by the updated clinical practice guideline by 2. Some important considerations include:
- Patients with physical limitations, such as cervical stenosis, Down syndrome, severe rheumatoid arthritis, cervical radiculopathies, Paget’s disease, morbid obesity, ankylosing spondylitis, low back dysfunction, retinal detachment, and spinal cord injuries, may not be candidates for this maneuver or may need specialized examination tables for performance of the maneuver, as noted in the guideline by 1.
- The patient may need to repeat the maneuver 3-5 times daily until symptoms resolve.
- Some people may experience nausea during the procedure, so it's recommended to move slowly between positions if needed.
- If symptoms persist after several days of performing the maneuver, the patient should consult a healthcare provider.
From the Research
Procedure for Performing the Epley Maneuver
The Epley maneuver, also known as the Canalith Repositioning Procedure, is a series of movements used to treat benign paroxysmal positional vertigo (BPPV) [ 3, 4, 5 ]. The procedure involves a series of specific head and body movements to help relocate the calcium particles (otoconia) in the inner ear that cause the vertigo.
Steps Involved in the Epley Maneuver
- The patient sits on an examination table with their legs extended [ 5 ].
- The patient is then helped to lie down on their back with their head turned to one side, usually the side that triggers the vertigo [ 5 ].
- The patient's head is then moved to the opposite side, while keeping their body in the same position [ 5 ].
- The patient is then helped to sit up and turn their head to the side that triggers the vertigo [ 5 ].
- The procedure is usually repeated several times until the vertigo symptoms are relieved [ 3, 4, 5 ].
Effectiveness of the Epley Maneuver
The Epley maneuver has been shown to be effective in treating BPPV, with success rates ranging from 70% to 90% [ 3, 4, 5, 6 ]. The procedure is usually performed by a healthcare professional, such as a doctor or physical therapist, but can also be performed by family doctors or emergency physicians [ 7 ]. The Epley maneuver is considered a safe and effective treatment for BPPV, with few side effects or complications [ 3, 4, 5, 6 ].