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Epley maneuver

  • Definition
    • The Epley maneuver is a series of head movements to relieve symptoms of benign positional vertigo. Benign positional vertigo is also called benign paroxysmal positional vertigo (BPPV). BPPV is caused by a problem in the inner ear. Vertigo is the feeling that you are spinning or that everything is spinning around you.

  • Alternative Names
    • Canalith Repositioning Maneuvers (CRP); Canalith-Repositioning Maneuvers; CRP; Benign positional vertigo-Epley; Benign paroxysmal positional vertigo-Epley; BPPV-Epley

  • Description
    • BPPV occurs when small pieces of bone-like calcium (canaliths) break free and float inside small canals in your inner ear. This sends confusing messages to your brain about your body's position, which causes vertigo.

      The Epley maneuver is used to move the canaliths out of the canals so they stop causing symptoms.

      To perform the maneuver, your health care provider will:

      • Turn your head toward the side that causes vertigo.
      • Quickly lay you down on your back with your head in the same position just off the edge of the table. You will likely feel more intense vertigo symptoms at this point.
      • Move your head to the opposite side.
      • Turn your body so that it is in line with your head. You will be lying on your side with your head and body facing to the side.
      • Sit you upright.

      Your provider may need to repeat these steps a few times.

  • Why the Procedure is Performed
    • Your provider will use this procedure to treat BPPV.

  • Risks
    • During the procedure, you may experience:

      • Intense vertigo symptoms
      • Nausea
      • Vomiting (less common)

      In a few people, the canaliths may move into another canal in the inner ear and continue to cause vertigo.

  • Before the Procedure
    • Tell your provider about any medical conditions that you may have. The procedure may not be a good choice if you have had recent neck or spine problems or a detached retina.

      For severe vertigo, your provider may give you medicines to reduce nausea or anxiety before starting the procedure.

  • After the Procedure
    • Epley maneuver usually works quickly. For the rest of the day, avoid bending over. For several days after treatment, avoid sleeping on the side that triggers symptoms.

  • Outlook (Prognosis)
    • Most of the time, treatment will cure BPPV. Sometimes, vertigo may return after a few weeks. About half the time, BPPV will come back later on. If this happens, you'll need to be treated again. Your provider may teach you how to perform the maneuver at home.

      Your doctor may prescribe medicines that can help relieve spinning sensations. However, these medicines often do not work well for treating vertigo.

  • References
    • Bhattacharyya N, Baugh RF, Orvidas L, Barrs D, Bronston LJ, Cass S, et al. Clinical practice guideline: Benign paroxysmal positional vertigo. Otolaryngology: Head and Neck Surgery. 2008;139(5 Suppl 4):S47-S81. PMID: 18973840

      Crane BT, Schessel DA, Nedzelski J, Minor LB. Peripheral vestibular disorders. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, PA: Elsevier Mosby; 2010:chap 165.

      Sacco RR, Burmeister DB, Rupp VA, Greenberg MR. Management of benign paroxysmal positional vertigo: a randomized controlled trial. J Emerg Med. 2014 Apr;46(4):575-81. PMID: 24462034