What is the treatment for Benign Paroxysmal Positional Vertigo (BPPV) using the Epley maneuver?

From the Guidelines

The Epley maneuver is the recommended first-line treatment for benign paroxysmal positional vertigo (BPPB) affecting the posterior semicircular canal, with a success rate of 80-90% after one or two treatments, as supported by the clinical practice guideline update in 2017 1. To perform the Epley maneuver, the following steps should be taken:

• Start with the patient sitting upright on an examination table.
• Turn the patient's head 45 degrees toward the affected ear.
• Quickly lay the patient down so their head hangs slightly over the edge of the table, maintaining the 45-degree rotation.
• Hold this position for 30-60 seconds until vertigo subsides.
• Next, rotate the head 90 degrees to the opposite side (now 45 degrees toward the unaffected ear) and hold for another 30-60 seconds.
• Have the patient roll their body to the side in the same direction their head is facing, maintaining head position, and hold for 30-60 seconds.
• Finally, return the patient to a sitting position. This sequence repositions displaced calcium carbonate crystals from the semicircular canal back to the utricle where they belong. The patient may experience brief vertigo during the procedure and should avoid sudden head movements for 48 hours afterward. If symptoms persist after multiple attempts, referral to an ENT specialist or vestibular therapist is appropriate, as BPPV can have a significant impact on individual health-related quality of life, and treatment can result in improvement in quality of life 1.

Key points to consider when treating BPPB include:

• BPPB is a common inner ear problem and cause of vertigo, with a high success rate of treatment using the Epley maneuver.
• The Epley maneuver is a simple and effective treatment that can be performed in a clinical setting.
• Patients may experience brief vertigo during the procedure, but this is usually temporary and resolves on its own.
• Avoiding sudden head movements for 48 hours after the procedure can help prevent recurrence of symptoms.
• Referral to an ENT specialist or vestibular therapist may be necessary if symptoms persist after multiple attempts at treatment.

From the Research

Treatment for Benign Paroxysmal Positional Vertigo (BPPV) using the Epley Maneuver

The Epley maneuver is a widely used treatment for BPPV, which is a syndrome characterized by short-lived episodes of vertigo in association with rapid changes in head position. The treatment involves a series of physical maneuvers that aim to reposition and disperse free-floating endolymph particles in the posterior semicircular canal.

Efficacy of the Epley Maneuver

• The Epley maneuver has been shown to be effective in treating posterior canal BPPV, with a significant reduction in vertigo symptoms and conversion of the Dix-Hallpike test from positive to negative 2, 3, 4.
• A systematic review of 11 randomized controlled trials found that the Epley maneuver was associated with a higher complete resolution of vertigo at 1 week compared to control groups (odds ratio 4.42,95% confidence interval 2.62 to 7.44) 3.
• Another study found that the Epley maneuver was more effective than vestibular rehabilitation at 1-week follow-up, with a risk difference of 10% to 55% 5.

Safety and Adverse Effects

• The Epley maneuver is generally considered safe, with no serious adverse effects reported in the studies reviewed 2, 3, 6.
• Some patients may experience nausea or discomfort during the maneuver, and those with cervical spine problems may not be able to tolerate the treatment 3.

Comparison with Other Treatments

• The Epley maneuver has been compared to other treatments, including vestibular rehabilitation and other particle repositioning maneuvers, such as the Semont and Gans maneuvers 3, 5.
• The evidence suggests that the Epley maneuver is comparable to these other treatments in terms of efficacy, but may have a higher recurrence rate of BPPV after treatment 3.