Epley maneuver and its procedure


The Epley maneuver or repositioning maneuver is a maneuver used by medical professionals to treat one common cause of vertigo, benign paroxysmal positional vertigo (BPPV) of the posterior or anterior canals of the ear. It works by allowing free-floating particles from the affected semicircular canal to be relocated, using gravity, back into the utricle, where they can no longer stimulate the cupula, therefore relieving the patient of bothersome vertigo.

Sequence of positions

The following sequence of positions describes the Epley maneuver:

  1. The patient begins in an upright sitting posture, with the legs fully extended and the head rotated 45 degrees towards the side in the same direction that gives a positive Dix–Hallpike test.
  2. The patient is then quickly lowered into a supine position with the head held approximately in a 30-degree neck extension (Dix-Hallpike position), with the head still rotated to the side.
  3. The clinician observes the patient's eyes for “primary stage” nystagmus.
  4. The patient remains in this position for approximately 1–2 minutes.
  5. The patient's head is then rotated 90 degrees in the opposite direction so that the opposite ear faces the floor while maintaining 30 degrees of neck extension.
  6. The patient remains in this position for approximately 1–2 minutes.
  7. Keeping the head and neck in a fixed position relative to the body, the individual rolls onto their shoulder, rotating the head another 90 degrees in the direction that they are facing. The patient is now looking downwards at a 45-degree angle.
  8. The eyes should be immediately observed by the clinician for “secondary stage” nystagmus (this secondary stage nystagmus should be in the same direction as the primary stage nystagmus). The patient remains in this position for approximately 1–2 minutes.
  9. Finally, the patient is slowly brought up to an upright sitting posture, while maintaining the 45-degree rotation of the head.
  10. The patient holds a sitting position for up to 30 seconds.

The entire procedure may be repeated two more times, for a total of three times.

During every step of this procedure, the patient may experience some dizziness.