The Epley Maneuver is a treatment for vertigo caused by a disorder called BPPV (benign paroxysmal positional vertigo). The cause of BPPV is thought to be calcium deposits within the inner ear, known medically as otoconia. Otoconia normally reside in two parts of the ear called the utricle and sacculem but when they abnormally make their way into the portion of the inner ear called the semicircular canals they can cause vertigo. BPPV usually occurs in one ear at a time and not bilaterally.
The Epley maneuver is an exercise intended to reposition the otoconia in the inner ear and get them into a different part of the ear where they will be less likely to cause symptoms.
The maneuver must be preformed by a qualified physician in a doctor's office. It takes about 15 minutes to complete. The Epley Maneuver may also be called the particle repositioning, canalith repositioning procedure or the modified liberatory maneuver. The exercise consists of four different head positions which are maintained for an average of 30 seconds each.
Before Having the Epley Maneuver
There are things you should tell your doctor before you have the Epley Maneuver. Specifically you should tell him if you have neck or back problems since the exercise involves rotating the head. Your doctor should also know if you have high blood pressure or history of a detached retina. Your doctor should give you exact instructions on what you should and should not do before your appointment but generally you should:
- stop eating four hours before your appointment
- dress comfortably
- If you are taking medication to prevent nausea or vertigo symptoms, such as Phenergan or Antivert, it may be wise to take them before your appointment.
During the Procedure
- While you are seated, the doctor will move you approximately 45 degrees in the direction of the affected ear.
- The doctor will tilt you backward so that you are both maintaining the original 45-degree position and leaning backward horizontally. The doctor continues to hold your head. It's good to hold on to the doctor's arms for support as a bout of vertigo usually occurs in this position. The doctor will hold you in this position until the vertigo stops.
- After the vertigo stops, your doctor will turn your head about 90 degrees in the direction of the unaffected ear, then roll you on to that side. You will now be looking at the floor. You may experience more vertigo at this point and will remain in this position until it stops.
- The doctor helps you back into a seated position and tilts your head down 30 degrees.
After the Epley Maneuver
Your physician should give you instructions before you leave his office which should supersede the advice given in this article. However, patients are often instructed to:
- wait at least 10 minutes before leaving the doctor's office
- have someone else drive you home
- sleep propped up at a 45-degree angle for the next two nights
- avoid any kind of exercise that involves head movement
- for one week sleep propped up on two pillows and avoid sleeping on the affected ear or side
- for one week you may need a soft cervical collar to maintain proper head position
- for one week try to stay as upright as possible
The Epley Maneuver has about a 65-95% percent chance of improving symptoms of benign paroxysmal positional vertigo and is superior to placebo maneuvers, though some patients may have to under go the procedure multiple times or explore other treatment methods for their condition.
American Speech-Language-Hearing Association. Vestibular Rehabilitation. Accessed: June 4, 2011 from http://www.umm.edu/otolaryngology/em.htm