Welcome to our educational page on the Epley Maneuver, a physical therapy technique used to treat benign paroxysmal positional vertigo (BPPV), the most common cause of vertigo. The Epley Maneuver is designed to relocate displaced otoliths (tiny calcium carbonate crystals) from the semicircular canals back to the utricle of the inner ear, where they can no longer cause vertigo.

What is BPPV?

BPPV is a disorder arising from a problem in the inner ear. Symptoms are repeated episodes of positional vertigo, a spinning sensation caused by changes in the position of the head. This condition is both uncomfortable and disorienting, but it's treatable with maneuvers like the Epley.

How the Epley Maneuver Works

The Epley Maneuver involves a series of specifically patterned head and body movements performed by a trained healthcare professional. The goal is to move the crystals causing vertigo from the semicircular canal back into the utricle.

Comprehensive Guide to BPPV and Side-Specific Treatments

Benign Paroxysmal Positional Vertigo (BPPV) is a prevalent inner ear problem causing vertigo due to dislodged calcium carbonate crystals (otoliths) in the semicircular canals. BPPV can affect different canals on either side of the ear, with specific maneuvers tailored for each type and side. This guide details the types of BPPV, their symptoms, and the recommended side-specific treatments.

1. Posterior Canal BPPV

Symptoms:

• Vertigo and nystagmus triggered by tilting the head back or lying down.

Treatment:

• Epley Maneuver (for both left and right sides)
• Left Side: Begin by turning the head 45 degrees to the left, then follow the sequence of movements to reposition the crystals.
• Right Side: Start with a 45-degree head turn to the right and proceed through the maneuver steps.
• The maneuver involves sequential head and body movements from sitting to lying down, with rotations of the head, and ends in a sitting position.

2. Horizontal (Lateral) Canal BPPV

Symptoms:

• Horizontal nystagmus and vertigo, often more intense than posterior BPPV, triggered by turning the head to the side while lying down.

Treatment:

• Lempert (Barbecue) Roll Maneuver
• For both Left and Right Sides: The patient is rotated in a 360-degree circle while lying down, in steps, starting with the affected ear facing down.
• This maneuver is designed to move the crystals out of the horizontal canal, regardless of the side affected.

3. Anterior Canal BPPV

Symptoms:

• Vertigo with upward and slightly torsional nystagmus.

Treatment:

• Deep Head-Hanging Maneuver
• Although the anterior canal is less commonly affected and more challenging to treat, this maneuver involves tilting the head far back for about 30 seconds, then bringing it back to an upright position slowly.
• This maneuver is similar for both sides since the anterior canal's position makes side-specific treatment less distinct.

Side-Specific Considerations

For each type of BPPV, the treatment is slightly modified based on the affected side to ensure the dislodged otoliths are effectively moved back into the utricle, where they no longer cause vertigo. After treatment, patients may be advised to avoid lying on the treated side for 24 hours and to sleep with their head elevated to prevent otoliths from slipping back into the sensitive areas of the semicircular canals.

Conclusion

BPPV, characterized by brief episodes of vertigo related to head movements, is highly treatable with maneuvers aimed at relocating dislodged otoliths. The choice of maneuver and its adaptation depend on the affected canal and side, necessitating accurate diagnosis and treatment by a healthcare professional experienced in vestibular rehabilitation.

‍