What's to know about the Epley maneuver?
Benign paroxysmal positional vertigo (BPPV) is caused by a problem in the inner ear. It is often associated with aging, but head injuries can also cause it.
The Epley maneuver can be carried out by a doctor or at home by the individual experiencing BPPV to relieve symptoms.
This article provides a step-by-step guide to the Epley maneuver and examines how the treatment works.
What is the Epley maneuver?
The purpose of the Epley maneuver is to dislodge crystals in the ear that may be affecting balance.
The Epley maneuver is a series of movements, normally carried out on a person by a doctor, to relieve the symptoms of BPPV. Research has found it to be an easy, safe, and effective treatment for the condition in both the long- and short-term.
The Epley maneuver is sometimes called the particle repositioning maneuver or the canalith repositioning maneuver.
These names are used because the maneuver involves a series of movements that help to reposition crystals in a person's ear that may cause feelings of dizziness. Repositioning the crystals helps to relieve the person's dizziness and nausea.
A doctor doing the Epley maneuver will manually move a person into a series of positions. It can also be done at home by the person experiencing the BPPV symptoms. The steps for both versions are detailed below.
Steps of the Epley maneuver carried out by a doctor
When a doctor carries out the Epley maneuver, they will perform the following steps:
- Ask the person to sit upright on an examination table, fully extending their legs out in front of them.
- Rotate the person's head at a 45-degree angle towards the side they are experiencing the worst vertigo.
- Quickly push the person back, so that they are lying down with their shoulders touching the table. The person's head is kept facing the side worst affected by vertigo but now at a 30-degree angle, so that it is lifted slightly off the table. The doctor holds the person in this position for between 30 seconds and 2 minutes, until their dizziness stops.
- Rotate the person's head 90 degrees in the opposite direction, stopping when the opposite ear is 30 degrees away from the table. Again, the doctor holds the person in this position for between 30 seconds and 2 minutes, until their dizziness stops.
- Next, they roll the person in the same direction that they are facing, onto their side. The side that they experience the worst vertigo on will be facing upwards. The doctor holds the person in this position for between 30 seconds and 2 minutes, until their dizziness stops.
- Finally, the doctor brings the person back up to a sitting position.
- The whole process is repeated up to three times, until the person's symptoms are relieved.
Steps of the Epley maneuver carried out at home
It is best for a doctor to carry out the Epley maneuver if the person experiencing BPPV has not used this method before.
Once a person has had the Epley maneuver performed by a doctor, they may want to repeat the process at home if they have further symptoms.
A person experiencing BPPV symptoms can follow these steps to gain relief at home:
- Sit up in bed with the legs extended in front of them and turn their head 45 degrees to the side that they are experiencing the most dizziness.
- Lie down, keeping their head turned to the side and lifted at a 30-degree angle away from the bed. They should stay in this position for 30 seconds to 2 minutes, until their dizziness stops.
- They should then turn their head 90 degrees in the other direction and stop when it is 30 degrees from the bed on the other side. Again, the person should hold this position for 30 seconds to 2 minutes, until their dizziness stops.
- They should now roll onto their side in the direction their head is facing, holding this position until the dizziness stops.
When to use
A doctor will use the Epley maneuver to help relieve a person's dizziness and nausea when they have decided that BPPV is the cause.
The Epley maneuver is not suitable to treat vertigo caused by something other than BPPV. If a person is unsure what is causing their vertigo, they should speak to a doctor and ask to be examined.
Other causes of vertigo include:
Having been shown the Epley maneuver by a doctor, someone with BPPV can repeat it themselves at home whenever they need to relieve their symptoms.
People often find it is useful to do the Epley maneuver before going to bed, as tossing and turning can trigger symptoms.
What is BPPV?
Dizziness, nausea, and vision problems are all potential symptoms of BPPV.
BPPV is a common type of vertigo that has been found to account for up to 17 percent of cases of dizziness.
It is caused by a problem in the inner ear. Small crystals called canaliths become loose in the inner ear. They can end up in the semicircular canals of the ear.
When these crystals move around, they cause fluid in the ear to be displaced. This results in a spinning sensation when a person moves their head to a different position. This spinning sensation is commonly referred to as vertigo.
The symptoms of BPPV come on quickly when a person with the condition moves their head. For example, symptoms can be triggered when turning over during the night.
Symptoms can last anywhere from a few seconds to several minutes, and include:
- visual disturbances
How the Epley maneuver works
The Epley maneuver is designed to put the head at an angle from where gravity can help relieve symptoms.
Tilting the head can move the crystals out of the semicircular canals of the ear. This means that they stop displacing fluid, relieving the dizziness and nausea this was causing.
In this way, the Epley maneuver relieves the symptoms of BPPV. However, it may need to be repeated more than once, as sometimes movements can dislodge the crystals after initial treatment.
After performing the Epley maneuver, a doctor will advise a person with BPPV to avoid movements that could dislodge the crystals. These movements include:
- bending over quickly
- lying down quickly
- tilting the head
- moving the head back and forth
The doctor may recommend that a person wears a soft collar to help them avoid making these movements. They may also be advised to sleep on two or three pillows so that their head is lifted at a 45-degree angle.
In the rare event that this treatment does not relieve BPPV symptoms, surgery on the ear canal may be a safe and effective option.