II. Indications
- Benign Paroxysmal Positional Vertigo (BPPV) affecting the posterior canal
III. Contraindications
- Severe Carotid Stenosis
- Unstable heart disease
- Cervical Spondylosis with Myelopathy
IV. Mechanism
- Reposition debris in labyrinth back into vestibule
- Debris starts in posterior semicircular canal
- Debris moves into utricle with procedure
V. Technique (Described for right ear, reverse for left)
- Patient sits upright facing examiner on right
- Examiner moves to head of table
- Examiner repositions hands to each side of head
- Rotate patient's head to left
- Head extended over edge of table
- Right ear upward
- Continue this position for 30 seconds
- Patient rolls onto left lateral decubitus position
- Rotate head leftward until nose is angle toward floor
- Continue this position for 30 seconds
- Assist patient to sitting position, facing left
- Repeat procedure until no Nystagmus on exam
VI. Post-Repositioning Procedure Instructions
- Turn head and neck as one unit for first week
-
Sleep reclined at 45 degrees for first 2 nights
- Recliner
- Pillows propped under head
- Do not sleep on affected side for the next 5 nights
- Put tennis ball in pocket on that side
- Pin pillow to affected side
- Return for symptom recurrence
- Procedure may need to be repeated
VII. Efficacy
- As effective as medication therapy and recommended as part of acute medical care (including ED care)
- Success rates vary, but highly effective in multiple studies
- Successful in 70% of first trials (approaches 100% on further attempts)
- Resolution in 50% of patients versus 19% for Placebo
VIII. Resources
- Canalith Repositioning at Home (Youtube, Bob and Brad)
- Canalith Repositioning on a Patient (YouTube, Bob and Brad)
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Therapeutic or Preventive Procedure (T061) |
| SnomedCT | 196470000, 103756006 |
| English | Epley maneuver was positive, Epley maneuver (physical finding), epley maneuvers, epley manoeuvre, epley maneuver, Epley maneuver, Epley maneuver (procedure), Epley manoeuvre |
| Spanish | maniobra de Epley (procedimiento), maniobra de Epley |
