Review of the Epley maneuver for BPPV

Benign paroxysmal positional vertigo (BPPV) is a syndrome characterised by short-lived episodes of vertigo in association with rapid changes in head position. It is a common cause of vertigo presenting to primary care and specialist otolaryngology clinics. Current treatment approaches include rehabilitative exercises and physical manoeuvres, including the Epley maneuver.

This review compared outcomes for 745 patients; outcome measures reported were resolution of vertigo symptoms, and conversion of Dix-Hallpike test form + to -.

BPPV occurs mainly between the ages of 50 and 70, and affects 36 patients per population of 100.000 per year.

Common causes are head trauma (17%) or ear infection (15%). BPPV can be caused by debris in the semicircular canal of the ear, which continues to move after the head has stopped moving. This causes a sensation of ongoing movement which conflicts with other sensory information. The Epley maneuver is a treatment that is performed by a doctor (or other health personnel with appropriate training, e.g. audiological scientist, physiotherapist) and involves a series of four movements of the head and body from sitting to lying, rolling over and back to sitting. It is understood to work by moving the canal debris out of the semicircular canal. 

The Epley manoeuvre is a safe, effective treatment for posterior canal BPPV, based on the results of 11, mostly small RCT’s with relatively short follow-up. There is a high recurrence rate of BPPV after treatment (36%). Outcomes for Epley manoeuvre treatment are comparable to treatment with Semont and Gans manoeuvres, but superior to Brandt-Daroff exercises.

Complete resolution of vertigo occurred in 56% of patients as compared to 21% in sham or control. No serious adverse effects were reported; rates of nausea varied between 17 and 32%.

This video demonstrates how the Epley manoeuvre is performed: