Epley

The Epley maneuver, also known as the canalith repositioning procedure, is a non-surgical treatment for benign paroxysmal positional vertigo (BPPV). It targets vertigo caused by dislodged otoconia (tiny crystals) in the posterior semicircular canal, moving them back into the utricle where they can no longer trigger symptoms.

Named after Dr. John Epley, an American otolaryngologist, the technique was described in the 1980s and has since become the most commonly used bedside treatment for posterior canal BPPV. It is frequently performed by clinicians in clinics and can sometimes be taught for home practice after proper instruction.

In brief, the procedure involves a sequence of head and body movements designed to relocate canaliths from the posterior canal. The patient sits upright with the head turned about 45 degrees toward the affected ear. The patient is then laid back quickly into a supine position with the head extended and rotated so the affected ear faces upward. After waiting about 30 to 60 seconds, the head is rotated 90 degrees to the opposite side, and the patient is rolled onto that side with the head tilted downward. After another 30 to 60 seconds, the patient is helped to sit up. Timings and exact angles may vary among practitioners.

Efficacy is generally high, with many patients experiencing rapid relief after one session and others requiring multiple visits. Potential side effects include transient vertigo, nausea, and neck discomfort. Contraindications include significant neck or spine problems or vascular conditions that would be worsened by the head positions; the maneuver should be performed by trained personnel. Related approaches for BPPV include the Semont maneuver and Brandt-Daroff exercises.