Epley maneuver

The Epley maneuver or repositioning maneuver is a maneuver used to treat benign paroxysmal positional vertigo (BPPV) of the posterior or anterior canals. It works by allowing free floating particles from the affected semicircular canal to be relocated, using gravity, back into the utricle, where they can no longer stimulate the cupula, therefore relieving the patient of bothersome vertigo. It is often performed by a medical doctor, occupational therapist, audiologist, physical therapist, Osteopath or chiropractor after confirmation of a diagnosis of BPPV using the Dix-Hallpike test and has a reported success rate of between 90–95%. This maneuver was developed by Dr. John Epley and Dominic W. Hughes, Ph.D. and first described in 1980. Physiotherapists, Osteopaths and some chiropractors now use a version of the maneuver called the "modified" Epley that does not include vibrations of the mastoid process originally indicated by Epley and Hughes, as they have since been shown not to improve the efficacy of the treatment.

The following sequence of positions describes the Epley maneuver:

The entire procedure may be repeated two more times, for a total of three times.

During every step of this procedure the patient may experience some dizziness.

Following the treatment, the clinician may provide the patient with a soft collar, often worn for the remainder of the day, as a cue to avoid any head positions that may once again displace the otoconia. The patient may be instructed to be cautious of bending over, lying backwards, moving the head up and down, or tilting the head to either side. Patients should sleep semi-recumbent for the next two nights. This means sleeping with the head halfway between being flat and upright (at a 45-degree angle). This is most easily done by using a recliner chair or by using pillows arranged on a couch. The soft collar is removed occasionally. When doing so, the patient should be encouraged to perform horizontal movements of the head to maintain normal neck range of motion.

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