From the Guidelines
The Epley maneuver for Benign Paroxysmal Positional Vertigo (BPPV) should typically be performed 1-3 times in a single session, with most practitioners recommending repeating it three times consecutively. This recommendation is based on the strongest and most recent evidence available, including the 2017 clinical practice guideline update on BPPV 1. The Epley maneuver works by using gravity to move the displaced otoconia from the semicircular canals back to their proper location in the utricle, where they no longer cause the false sensation of movement that triggers vertigo.
Key Points to Consider
- The maneuver can be repeated daily for up to two weeks or until symptoms resolve 1.
- If symptoms persist after two weeks of daily maneuvers, patients should consult a healthcare provider for reassessment.
- Most patients experience significant improvement after 1-3 treatment sessions, though some may require additional sessions for complete resolution of symptoms.
- The 2017 clinical practice guideline update on BPPV recommends treating patients with posterior canal BPPV with a canalith repositioning procedure, such as the Epley maneuver, as initial therapy 1.
Important Considerations for Patient Care
- Patients should be informed that nausea, occasional vomiting, and/or a sense of falling may arise during the Epley maneuver 1.
- Patients who previously manifested severe nausea and/or vomiting with the Dix-Hallpike maneuver may be offered antiemetic prophylaxis 30 to 60 minutes prior to the Epley maneuver 1.
- Clinicians should reassess patients within 1 month after an initial period of observation or treatment to document resolution or persistence of symptoms 1.
From the Research
Epley's Maneuver for BPPV
The Epley's maneuver is a widely used treatment for Benign Paroxysmal Positional Vertigo (BPPV). The number of times the maneuver should be performed varies depending on the study.
- A study published in 2014 2 compared the effectiveness of the Epley maneuver with vestibular rehabilitation and found that the Epley maneuver is more effective at 1-week follow-up, but the evidence is inconsistent at 1-month follow-up.
- Another study published in 2023 3 investigated the effectiveness of alternated Epley and Semont maneuvers and found that alternated maneuvers were more effective than repeating the same maneuver.
- A randomized controlled trial published in 2014 4 aimed to evaluate the effectiveness of the Epley's maneuver performed by general practitioners in primary care, but the results are not directly relevant to the question of how many times the maneuver should be performed.
- A multicenter randomized double-blind study published in 2014 5 compared the Epley, Semont, and sham maneuvers and found that the Epley maneuver was significantly more effective per maneuver than the Semont or sham maneuvers.
- A prospective study published in 2000 6 compared the effectiveness of the Epley and Semont maneuvers and found that both maneuvers were effective, with 60% of patients being without nystagmus after a single use of either maneuver.
Frequency of Epley's Maneuver
The frequency of the Epley's maneuver varies depending on the study.
- The study published in 2023 3 found that alternated Epley and Semont maneuvers were more effective than repeating the same maneuver, with 84.5% of patients achieving absence of positional nystagmus after two maneuvers.
- The multicenter randomized double-blind study published in 2014 5 found that the Epley maneuver was effective after a single maneuver, with 63.9% of patients achieving resolution of positional nystagmus, and after a second maneuver, with 83.3% of patients achieving resolution.
- The prospective study published in 2000 6 found that 60% of patients were without nystagmus after a single use of either the Epley or Semont maneuver, and more than 90% of patients were without nystagmus at the end of the study, with a median value of subjective improvement of 90%.