Epley Maneuver

Let us first understand what is BPPV or Vertigo? Vertigo in layman term means dizzy spells or feeling of an imbalance that makes you feel lopsided, you might feel as if the entire world around you is spinning but in actual it is an inner ear problem that causes these dizzy spells. You may often find yourself swaying or feel tilted and even feel a pull toward one direction; all of these are symptoms of vertigo. Some causes of vertigo are as below:

  • BPPV means benign paroxysmal positional vertigo. It occurs when there is a deposit of calcium particles in the canals of the inner ear. Mostly associated with age BPPV mostly bothers senior citizens.
  • An inner ear problem called Meniere’s disease causes build up of water or other fluids in the ear and thus causing a pressure that result in episodes of vertigo along with hearing lose.
  • A viral infection called Vestibular neuritis also causes vertigo. This causes inflammation in the nerves surrounding the inner ear.
  • Sometimes Vertigo is also associated with injuries of the head and the neck, migraine, sinusitis, tumour or stroke in the brain and even medications that can cause damage to the ear.

The only treatment available for Vertigo or BPPV is Epley Maneuver. To understand the treatment and how beneficial this can prove for persons suffering from Vertigo, let us understand what is Epley Maneuver?

What is Epley Maneuver?

In medical terminology, Epley Maneuver is a repositioning procedure that is used to treat BPPV or vertigo in the ear canals, either in the posterior or interior parts. Mostly a doctor who is an ENT specialist, audiologist, osteopath or a chiropractor will use Dix-Hallpike test to confirm diagnosis of BPPV. The procedure enables free floating particles to be placed back in the utricle of the ear canal from the affected area by using gravitational techniques. These particles are relocated from the affected part of the semicircular canal so that they may not cause any further stimulation of the cupula, hence the vertigo can be corrected.

Procedure of Epley Maneuver

It was a procedure developed by Dr. John Epley and Dominic W.Hughes in 1980. Once the Dix-Hallpike test confirms presence of Vertigo or BPPV ailment then the doctor is like to perform Epley Maneuver’s in step wise sequences. The procedure of Epley Maneuver is as below:

Step 1

The doctor is likely to make you sit in an upright position wherein your legs are extended in front. Now the patients head is tilted at an angle of 45 degrees towards the side. Now without the doctor having to change your head position, you will be quickly guided to a position wherein your shoulders are on table while your head is hanging on the fringe of the examination table. During this position your BPPV or Vertigo is facing down, that is towards the floor. This position is held for 30 second to a minute till the time the vertigo has come to a closing stage. This step also helps doctor to understand primary stage of nystagmus or a condition that causes rapid and an uncontrolled eye movement.

Step 2

In step 2, the doctor turns your neck to enable you to look at 45 degrees on the opposite side (this means that if you were made to look on the left in the first step then now you are looking in the right hand direction), this is done without lifting your head. This position too is held for 30 seconds to a minute so as to understand secondary stage of nystagmus or until the vertigo has stopped completely.

Step 3

In step 3, the doctor will now help you to turn to one particular side so that the vertigo will be facing upward. This position too is maintained for 30 seconds to a minute until the vertigo comes to an end completely.

Step 4

This is the last step wherein the doctor helps you to sit back with your legs hanging on the examination table on the similar side as in step 3. This manipulation or maneuver is a 10 to 15 minutes session that is all what is needed to treat the vertigo. Usually done in assistance of a therapist or a clinician, the head is moved in different positions to control the movement of calcium debris or particles therefore helping a patient to overcome the vertigo ailment.

This maneuver is done with the assistance of a doctor or physical therapist. When the patient’s head is securely moved into various positions, the crystal debris called the canaliths that are main cause of vertigo will move without restraint and no longer cause vertigo. Patients might feel some kind of dizziness during the procedure but once treated, this is likely to help in the longer run.

Post the treatment, Patient is provided with soft collar to be worn through out the day so as to avoid displacement of Otoconia. The patient is also asked to avoid too much bending, rotating head in different directions or even lying backwards. The patient is additionally advised to sleep in a position where the head is rested at 45 degrees angle. This is to be followed for two nights and can be done by using a recliner chair or arranging the pillows in a said manner on the couch.

Sometimes 2 to 3 sessions of the above procedure are required to attain a successful outcome. But Epley Maneuver is one of the most effective treatments for correcting vertigo or BPPV. This procedure helps in restoring the balance in the vestibular system. Once the free floating particles that get displaced from the otolithic membrane of the canal, they cause a misbalance and hence Vertigo appears.

Hope the procedure was easy for you to comprehend. Do not try this at home if you have been diagnosed with Vertigo. It is always a good practice to show your self to the doctor who can then treat you in accordance with the procedure of Epley Maneuver.

Epley Maneuver Diagram

Epley Maneuver Diagram

Epley Maneuver Diagram

Epley Maneuver Video

Last modified on September 5th, 2017 at 9:10 am

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