Epley Maneuver to Treat BPPV Vertigo

Benign paroxysmal positional vertigo (BPPV) is the most common form of positional vertigo, accounting for nearly one-half of patients with peripheral vestibular dysfunction. It is most commonly attributed to calcium debris within the posterior semicircular canal, known as canalithiasis. While symptoms can be troublesome, the disorder usually responds to treatment with particle-repositioning maneuvers, an office-based procedure and one that patients can be taught to perform at home. The Epley maneuver or repositioning maneuver is a maneuver used to treat 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.

Symptoms:

Patients with benign paroxysmal positional vertigo (BPPV) present with recurrent episodes of vertigo that last one minute or less. Episodes are provoked by specific types of head movements, such as looking up while standing or sitting, lying down or getting up from bed, and rolling over in bed. The vertigo may be associated with nausea and vomiting.

Hearing loss or symptoms are typically absent. Patients with BPPV typically have no other neurologic complaints. Some patients have evidence of prior inner ear damage. Approximately half of patients complain of imbalance between attacks, even after successful treatment.

Treatment:

Benign paroxysmal positional vertigo (BPPV) is treated effectively in most cases using particle repositioning maneuvers.
Particle repositioning maneuvers. These are the treatment of choice for posterior canal BPPV and include:

– The Epley maneuver and modified Epley maneuver
– The Semont maneuver and modified Semont maneuver

The treatment maneuvers encourage the debris to migrate toward the common crus of the anterior and posterior canals and exit into the utricular cavity. These maneuvers may be effective when the history is highly suggestive of BPPV, even if nystagmus is not seen on examination.

Eply Maneuver – Particle repositioning maneuver In patients with benign paroxysmal positional vertigo (BPPV) due to posterior canal canalithiasis, the particle repositioning maneuver encourages the calcium carbonate debris to migrate toward the common crus of the anterior and posterior canals and exit into the utricular cavity. Step 1 is the standard Dix-Hallpike positioning test. Note that this illustration demonstrates the maneuver for right-sided BPPV.
Modified and reproduced with permission from: Foster CA, Baloh RW. Episodic vertigo. In: Rakel (Ed), Conn’s Current Therapy, 47th ed, WB Saunders, Philadelphia, 1995. p.873.
Graphic 61361 Version 5.0
©2017 UpToDate®

Modified Epley maneuver for self-treatment of benign positional vertigo (LEFT) 
This maneuver should be carried out three times a day. Repeat this daily until you are free from positional vertigo for 24 hours.
Reproduced from Http://www.charite.de/ch/neuro/englishL.htm
Graphic 50861 Version 2.0
©2017 UpToDate®

Modified Epley maneuver for self-treatment of benign positional vertigo (RIGHT) 
This maneuver should be carried out three times a day. Repeat this daily until you are free from positional vertigo for 24 hours.
Reproduced from http://www.charite.de/ch/neuro/englishL.htm
Graphic 62612 Version 2.0
©2017 UpToDate®

 

References for this post:
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http://www.FauquierENT.net – Video demonstrates how the Epley maneuver is performed to treat POSTERIOR canal BPPV affecting the right ear. Animation showing what is going on within the inner ear is also shown in the 2nd half of the video.

For more information:
http://www.FauquierENT.net/bppv.htm

Watch how the inner ear balance system works here:
https://www.youtube.com/watch?v=YMIMvBa8XGs

Perform Dix-Hallpike to determine what type of BPPV here:
https://www.youtube.com/watch?v=wgWOmuB1VFY

POSTERIOR canal BPPV treated by Epley maneuver here:
https://www.youtube.com/watch?v=9SLm76jQg3g

LATERAL canal BPPV treated by Lempert maneuver here:
https://www.youtube.com/watch?v=mwTmM6uF5yA

SUPERIOR canal BPPV treated by Deep Head-Hanging here:
https://www.youtube.com/watch?v=qw1QciZWfP0

Flowchart for BPPV diagnosis and treatment can be found here:
http://www.fauquierent.net/bppv1.htm

Video on Meniere’s Disease:
https://www.youtube.com/watch?v=qrk7OyAB_ss

 

 

 

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