Epley maneuver

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What is the Epley maneuver?

The Epley maneuver is a multi-step repositioning treatment designed to slowly move the otoliths from the posterior semicircular canal to the utricle, in order to alleviate symptoms associated with Benign Paroxysmal Positional Vertigo.

What is Benign Paroxysmal Positional Vertigo (BPPV)?

Benign Paroxysmal Positional Vertigo is a clinical diagnosis characterised by episodes of objective vertigo lasting less than 60 seconds, occuring as a result of certain head positions. This condition may lead to nausea and nystagmus, a rapid and involuntary movement of the eyes.

Why perform the Epley maneuver?

Several maneuvers have been developed to reposition otoliths and treat some forms of vertigo, also known as labyrintholithiasis. Epley's maneuver serves as the therapeutic intervention for Benign Positional Paroxysmal Vertigo (BPPV).

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How to do the Epley Maneuver

The maneuver is divided into three distinct steps:

  • Step 1: The physician seats the patient on the couch, holds the patient's head with their hands, and swiftly rotates it 45 degrees to the right or left, depending on the treatment. Simultaneously, the patient is guided to lie down, ensuring the head ends up slightly lower than the trunk.
  • Step 2: The physician further rotates the patient's head by 90 degrees, transitioning from a 45-degree right rotation to a 45-degree left rotation, maintaining this position for an additional 30 seconds.
  • Step 3: The physician asks the patient to rotate to the left, shifting weight onto the left shoulder with their face facing floor of the room. A resting period in this position lasts for another 30 seconds.

Upon completion of the third phase, the patient returns to the initial sitting position on the couch. Keep in mind that these maneuvers should not be attempted without the assistance of a trained medical professional.

After the procedure

The post-treatment phase is just as important as the treatment. 

In the days following the treatment, a good night's sleep is the best cure. It is recommended to sleep leaning back on a bed at a 45-degree angle, or on a recliner chair. Those who are not used to sleeping on their backs may find it difficult to be able to rest in this position. It is quite common to experience an almost sleepless first night.

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What are the risks of the Epley maneuver?

The Epley maneuver is considered a safe maneuver. 

However, there are potential risks if it is not performed correctly.

These include: 

  • Possible injuries to the neck or back.
  • Temporary worsening of vertigo symptoms.
  • Irritation of the vestibular apparatus within the inner ear.

Is doing the Epley Maneuver at home safe?

Given the delicacy of the movements involved in the Epley maneuver, it is always advisable to refer to a professional with a specialisation in otolaryngology to prevent potential mishaps that may arise from attempting to 'do-it-yourself'.
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FAQ on the Epley Maneuvre

What should you not do after Epley maneuver is performed?

After a treatment, it is of paramount importance for the patient to avoid abrupt movements, flexions or extensions of the neck for at least 2-3 days.

Can I perform the Epley maneuver on both sides?

The Epley maneuver can be performed on either the right or left side, depending on the patient's symptoms and needs.

How effective is the Epley maneuver?

In 90% of cases, the Epley maneuver improves the patient's condition, providing an immediate feeling of relief.

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