Epley maneuver

Description

A particle repositioning maneuver for the treatment of BPPV – with the aim of moving the canaliths out of the posterior semicircular, back into the utricle. It have been shown to be safe and can be effective at resolving BPPV in 50-85% of cases (2014, 2013).

The original maneuver was first described by John Epley in 1980 also involved vibrations over the mastoid during the maneuver. Today the Modified Epley is performed without the vibrations.

How to perform the Modified Epley Maneuver

They Epley maneuver for right sided BPPV:

• The patient sits upright and turns head 45° towards the right (affected ear)
• Keeping their head turned the patient lies back and hangs their head off the end of bed to extend the neck to around 20degrees beyond horizontal, supported by the examiner
• Hold this position for 30sec, until the nystagmus and vertigo has resolved
• Keeping the head extended rotate the head to 45° to the left
• Hold this position for 30sec, until the nystagmus and vertigo has resolved
• Keeping the head turned at 45°, roll the whole body onto the left side so that the patient is now looking down at the floor
• Hold this position for 30sec, until the nystagmus and vertigo has resolved
• Keeping the head turned to 45° left, sit the patient up
• Return the head to the midline and tilt it forwards to around 30° so the patient is looking slightly down

The maneuver can be repeated until symptom resolution. It should be performed in the opposite direction for left sided BPPV with the head turning to the left side in the initial step.

See clinical case for an animation of the maneuver, or see below for a longer video on BPPV and the Epley maneuver directed and featuring John Epley himself (see 39m15s for animation of the maneuver).

History of the Epley maneuver

Associated Persons

• John McNaughton Epley (1930 – 2019)

Alternative names

• Epley manoeuvre
• Modified Epley
• Canalith repositioning manuever

Controversies

Epley faced over a decade of scepticism and ridicule from peers in his field who did not believe in his repositioning manoeuvre, before it was widely accepted.

References

Original articles

• Epley JM. New dimensions of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 1980; 88(5): 599-605.

Epony review

• Parnes LS, Agrawal SK, Atlas J. Diagnosis and management of benign paroxysmal positional vertigo (BPPV). CMAJ. 2003;169(7):681-693.
• Prokopakis E, Vlastos IM, Tsagournisakis M, Christodoulou P, Kawauchi H, Velegrakis G. Canalith repositioning procedures among 965 patients with benign paroxysmal positional vertigo. Audiol Neurootol. 2013;18(2): 83-88
• Hilton  MP, Pinder  DK. The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database of Systematic Reviews 2014; 12: CD003162

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