Epley maneuver is a series of controlled moves of the head and body that are used to move an inner ear crystal back into place in individuals with the correct type of benign paroxysmal positional vertigo (BPPV).
The most common causes for vertigo are: BPPV. It happens when the tiny crystals of calcium carbonate called otoconia, get dislodged in one of the inner ear’s semicircular canals.
These canals typically assist the brain to recognize the movements of the head. Loose crystals flow inside causing abnormal signals to the brain when the head is changed position, resulting in a sudden spinning sensation.
A canalith repositioning maneuver (CPM), or Epley maneuver, is a series of moves designed to help dislodge these crystals from the affected semicircular canal and get them where they are not causing positional vertigo.
Epley manoeuvre is not effective for all dizziness or vertigo. It is particularly used in cases of BPPV that are appropriate.
Why is BPPP a cause of vertigo?
The cause of BPPV is an interference with the inner ear’s normal balance signals by the movement of displaced calcium crystals within a semicircular canal, leading to vertigo.
There is a balance system (vestibular system) in the inner ear. It assists the brain to know where the head is and how it’s moving.
Otoconia are normally found in a utricle. These crystals can detach and fall into a semircular canal.
When you:
- Turn over in bed
- Sit up from lying down
- Look up
- Look down
- Bend over
- Shake your head quickly
The crystals are able to move around inside the canal.
This motion has the potential to stimulate the balance system improperly resulting in:
- Sudden spinning
- Nausea
- Loss of balance
- A feeling of motion in the room.The sensation of a moving room.
- Short attacks of dizziness
- Uncontrolled eye movements or “nystagmus”
Short episodes of vertigo with a change of head position are a common feature of BPPV problems.
What is It about the Epley Maneuver?
The Epley maneuver is a series of head and body positions that help move the floating crystals out of the involved semicircular canal.
Imagine the semi-circular canal is a small curved tube that has fluid in it.
Crystals passing through this passage may move as head moves. The Epley maneuver, which is a maneuver to harness the force of gravity and apply controlled positioning, is used to encourage the crystals to flow through the canal and back into the utricle.
The rule is:
Chips displace → control head movements → crystals pass through canal and go back to a safe place → positional vertigo gets better.
The manoeuvre does not break down or vaporize the crystals.
Rather, it tries to re-place them.
Hence, it’s also known as a canalith repositioning procedure (CRP).
In which cases is the Epley Maneuver recommended?
If a healthcare professional has determined that the symptoms are due to the type and location of BPPV that the Epley maneuver is intended to treat, it is generally recommended.
The most common situation is posterior-canal BPPV.
The doctor will assess before treatment:
- History of the patient’s vertigo.
- Duration of each episode
- What type of movement causes symptoms to happen?
- Positional testing – eye movements
- Which ear is impacted?
- Which of the 3 semi-circular canals is effected?
A positional test like a Dix-Hallpike test may be helpful in making a diagnosis for the best type of BPPE. The doctor will then move the patient’s head and body in various positions during the test and look for the typical nystagmus.
This is important as the Epley maneuver may not give the desired result if the affected side or type of BPPV is not known.
Are the Epley Maneuver and the Dix-Hallpike Test one and the same?
No. The Dix-Hallpike maneuver is mainly a diagnostic test and the Epley maneuver is a treatment for repositioning the displaced crystals in the correct BPPV.
Both require a change in the position of the head and body and sometimes both are confused.
Dix-Hallpike maneuver
Can be used to help identify if a person has a specific type of BPPV.
Epley maneuver
To treat the appropriate BPPV once identified and side determined.
In simple terms:
Dix-Hallpike = helps diagnose
Epley = helps treat
A positional test can be performed first by a doctor, then an appropriate repositioning maneuver if the doctor is sure it is BPPV.
How to do the Epley Maneuver?
Each maneuver is a position of the head and body that lasts long enough to allow the displaced crystals to pass through the involved canal.
The order will change with the affected ear and canal.
One of the more standard sequences on the right is:
- Patient begins to sit up.
- Head is facing the affected side.
- The patient is carefully rolled onto his/her back with head turned.
- Head then turns away from the other side.
- The patient’s head and body are turned to the other side.
- The patient is brought back to the sitting position.
- The opposite direction is for the left-side move.
The main goal of these movements is to help the displaced crystals pass through the semi-circular canals by means of gravity.
Important
Patients should never assume that the right-sided or left-sided maneuver is appropriate – this should be done after determining which ear is affected.
Maneuvering will vary according to diagnosis.
How do doctors know which ear is affected by BPPV?
The affected side is identified by the examination of the patient’s symptoms and by the usual eye movements that occur during positional testing.
The Dix-Hallpike test is a common test for posterior-canal BPPV.
During the examination, the doctor observes:
- Whether vertigo is triggered is a subject of great debate.
- In what position does it happen?
- The direction and type of nystagmus.
- To respond at the right time,
- Whether the findings are consistent with BPPV
This information can guide the clinician to the side to be treated and determine whether an epley manoeuvre is indicated.
Partly, this is why “I feel dizzy, I will do the Epley manoeuvre” isn’t always the best solution.
All dizziness is not caused by BPPV.
Does the Epley Maneuver Work for All Types of BPPV?
No. The Epley maneuver is most often used for the correct type of posterior-canal BPPV and other BPPV types might need a different repositioning maneuver.
There are more than one semicircular canal in the inner ear.
Further displaced crystals may be in another canal and the clinician might prescribe another maneuver depending on the location and type of BPPV.
That’s why it’s important to get the correct diagnosis first when treating BPPV.
The idea is the same;
Determine which canal is affected → choose the correct maneuver → move the crystals.
If crystals are not in the back of the semicircular canal, slightly different repositioning maneuvers may be necessary, Johns Hopkins says.
How fast does the Epley Maneuver take?
There is a substantial improvement in many after a successful repositioning maneuver, but some patients may require repetition of this maneuver, or may have mild imbalance for a short period after the maneuver.
It depends on the individual.
Patients may report that the spinning sensation is gone following treatment.
Others may require:
- One or more repositioning maneuver additional repositioning maneuver.
- Follow-up evaluation
- Treatment of a different canal
- Vestibular rehabilitation
If symptoms are ongoing, further investigation should be carried out.
Why am I still dizzy after the Epley maneuver?
If symptoms continue after an Epley maneuver, it does not indicate the maneuver was unsuccessful, it just indicates a further evaluation is needed.
There are a number of possible reasons.
The crystals may not have been completely repositioned
A few patients need a second treatment session.
This side might not have been the correct side
The Epley maneuver needs to correspond to the affected ear.
A different semicircular canal might be affected
A different realignment might be more suitable.
The dizziness could be caused by another factor
Dizziness is not a typical symptom of BPPV.
Other causes may be other vestibular disorders, dizziness caused by migraine, medication side effects or neurological diseases.
Is it possible for BPPV to return following the Epley Maneuver?
Yes. Even after successful treatment with the Epley maneuver, BPPV can reoccur. If you are successful in repositioning, it doesn’t mean that BPPV is never going to return. The new episode may happen if other crystals get out of place and fall into a half circle canal.
A patient might find that the same position ‘rhythm’ is coming back:
- When lying down in the bed, spinning when turning.
- Vertigo when sitting up
- Variably experienced dizziness on upgaze
- When bending over, spinning movements are performed
Patients who have already had BPPV may benefit from an understanding of symptoms, as well as knowing when to seek a second evaluation for BPPV, since it is one of the reasons.
Can You Do the Epley Maneuver at Home?
Yes, a home Epley maneuver can be indicated for some patients that had previously undergone evaluation and diagnosis of a specific type of BPPV.
Before a patient learns to perform the maneuver at home, the maneuver may be first performed in the clinic by a healthcare professional and then the patient is instructed by the healthcare professional on how to perform the home version.
The home Epley maneuver is suggested by a health care provider if the history and physical examination are suggestive of BPPV and the health care provider may be able to tell you which ear is involved.
Self-treatment is however not suitable for all.
People with certain:
- Neck problems
- Back problems
- Vascular conditions
- Retinal conditions
may require special medical guidance before trying the maneuver.
Before using the Epley maneuver, it would be better to have been evaluated if you have never had a diagnosis of BPPV.
The Epley Maneuver is Safe?
When properly executed, the Epley maneuver is a safe treatment for BPPV that is generally effective, but may not be appropriate for all patients and may temporarily induce vertigo.
Patients might experience:
- Brief spinning
- Nausea
- Temporary imbalance
- Anxiety due to the recurrence of the vertigo.
These sensations may happen as a result of the manoeuvre intentionally taking the head through head positions that impact the vestibular system.
Persons with substantial neck or back issues, some vascular issues or retinal issues should seek advice on the safety of the maneuver from a care provider.
After the Epley’s: What Do You Do?
Once the Epley maneuver has been performed, it is advisable to move slowly and carefully, and the doctor’s directions should be followed.
Patients will experience temporary feelings of:
- Slightly unsteady
- Tired
- Mildly dizzy
- Dislikes sudden head movements
If still dizzy, do not drive or do activities which may cause dizzy spells to occur suddenly, and thus cause harm to yourself or others.
Your doctor also may recommend sleeping positions, or specific head movements.
Is it safe for you to drive after the epley maneuver?
Do not drive until you are certain that you are not dizzy anymore and can move around safely.
The Epley maneuver itself can induce temporary dizziness.
If you have had the maneuver done in a clinic, talk to the person performing the maneuver to see if transportation home is necessary.
How Many Epley Maneuvers?
No one schedule fits all patients. The frequency should be according to the instructions of the healthcare professional who has diagnosed the BPPV. For some patients, they may need to be repositioned more than once. This does not imply that the maneuver should be repeated by all people with dizziness. If it is not helping, it is important to consider the diagnosis again, not repeat the repetition.
Are Epley Maneuver and BPPV Exercises the same?
No. Other exercises may serve other purposes and be used in other situations, whereas the Epley maneuver is specifically a canalith repositioning exercise.
The Epley maneuver is a technique that involves repositioning of the displaced crystals.
Additional vestibular exercises might be suggested for BPPV circumstances, or as part of rehabilitation.
The right strategy will depend on:
- Type of BPPV
- Affected semicircular canal
- Affected side
- Patient’s symptoms
- Medical history
The reaction to the previous treatment.
Thus, “BPPV exercise” should not be synonymous with “Epley maneuver.
When is the best time to get an ENT for BPPV?
When spinning episodes occur regularly with head movement, with activity or when falls occur, or despite repositioning treatment, an ENT evaluation should be considered.
An ENT assessment is particularly important if:
- Severe vertigo is your first episode of severe vertigo.
- Don’t know if you have BPPV
- The Epley maneuver has not been useful in these patients.
- Vertigo keeps returning
- This is a lot of imbalance.
- You experience hearing loss or tinnitus and vertigo.
- You have other neurological symptoms
- Have a history of ear disease or ear surgery.
The treatment for BPPV can be very effective, but it is not always that all dizziness episodes are BPPV. It’s important to mention that there are other inner ear and neurologic disorders that can cause dizziness and imbalance symptoms, according to Johns Hopkins.
When is Vertigo an Emergency?
If a person experiences symptoms of sudden vertigo with new neurologic symptoms, it should be considered an emergency medical situation, not just BPPV.
If vertigo is accompanied by the following symptoms, medical evaluation is required, and should be done quickly:
- New weakness
- Numbness
- Difficulty speaking
- Facial weakness
- Double vision
- Severe new headache
- Loss of consciousness
- Severe difficulty walking
- Other acute neurologic alterations
A typical BPPV presentation is distinct from vertigo that is associated with neurological symptoms.
Don’t repeat the home maneuver when unsure if symptoms are related to BPPV, seek medical evaluation.
What is the treatment of BPPR at Bharti ENT care in Vadodara?
Unlike other clinics that may not recognize the possibility of BPPV, Bharti ENT Care’s Vertigo Clinic categorically treats and assesses BPPV as one of the conditions it treats.
Conditions that the clinic treats at its Vertigo Clinic include benign paroxysmal positional vertigo (BPPV), Ménière’s syndrome and vestibular neuritis.
A patient evaluation may involve:
1. Understanding the patient’s symptoms
The doctor will first find out if the patient is experiencing true positional vertigo or other forms of dizziness.
Questions may include:
- Does the room spin?
- What is the length of the episode?
- Does it occur when you get into bed?
- Does research cause a look-up?
- Does sitting up make it happen?
- Do you experience hearing symptoms?
- Do you recall this occurring before?
2. Positional assessment
Positional testing may be indicated if a BPPV is suspected to differentiate the signs and symptoms of BPPV from other possible causes of both eye and positional abnormalities and to suggest the affected side.
3. Choice of the right maneuver
When the diagnosis is confirmed, the physician can choose the proper repositioning maneuver depending on which canal and on which side of the body the BPPV is located.
4. Follow-up if symptoms persist
If the symptoms don’t go away, the team may need to review the diagnosis of BPPV and consider that there is another canal involved or another cause of dizziness to investigate.
What is the best place to be evaluated to get BPPV Treatment in Vadodara?
For patients searching for BPPV treatment in Vadodara, Epley maneuver in Vadodara, positional vertigo treatment or a vertigo specialist in Vadodara, Bharti ENT Care Hospital has its main hospital at Kunj Centrum on Nizampura Main Road.
Not just any place that performs an Epley maneuver is of importance for patients coming from Gotri, Nizampura, Akota, Karelibaug, Manjalpur, Sama, Bhayli, Waghodia, Makarpura and the area around these villages.
The question of whether the patient is diagnosed correctly with BPPV and whether the correct positioning manoeuvre(s) are being used is more important.
Why is it essential to receive the proper treatment for BPPV?
You might be tempted to google an “Epley maneuver for vertigo”, watch a video and then copy the movements at home.
However, the Epley maneuver is a technique for a specific issue, namely, displaced crystals in a specific region of the vestibular system.
If the dizziness is not caused by this, doing this maneuver multiple times may not resolve the issue.
An accurate assessment can contribute to answering:
- Does this sound like BPPV?
- Which ear is affected?
- Which s.c. is affected?
- Would the Epley maneuver be appropriate?
- If the maneuver is already performed, why are the symptoms still occurring?
This distinction is particularly crucial for individuals who reside in Vadodara and its surrounding areas, as frequent dizziness can impact their walking, work, driving, sleep and confidence for their everyday activities.
Vertigo Clinic at Bharti ENT Care mentions BPPV and other vestibular disorders, and says that it offers diagnostic evaluation and tailored treatment for these conditions.
The purpose should not, however, be to merely “stop the spinning.
The aim is to find out the cause of the spinning, to select the right treatment and to ensure that any persistent or recurring symptoms are adequately assessed.
Frequently Asked Questions About the Epley Maneuver
What is the Epley maneuver?
The Epley maneuver is a sequence of head and body movements used to reposition displaced inner-ear crystals in appropriate cases of BPPV.
How does the Epley maneuver work?
It uses controlled changes in head and body position to help move displaced calcium crystals out of a semicircular canal and back toward the utricle.
Does the Epley maneuver cure BPPV permanently?
It can effectively treat an episode of appropriate BPPV, but BPPV can recur in the future. Repeat treatment may sometimes be necessary.
Can I do the Epley maneuver at home?
Some people can perform a home Epley maneuver after a healthcare professional has confirmed the appropriate BPPV diagnosis and taught them the correct technique. It is not suitable for everyone.
How do I know which side of BPPV I have?
The affected side is usually determined through the patient’s symptoms and positional testing, such as the Dix-Hallpike maneuver for appropriate posterior-canal BPPV.
Why am I still dizzy after the Epley maneuver?
Persistent dizziness can occur because the crystals were not fully repositioned, another canal is involved, the maneuver was not appropriate or another condition is causing the symptoms. Persistent symptoms should be reassessed.
Is the Epley maneuver safe?
It is generally considered safe for appropriate patients, but people with certain neck, back, vascular or retinal conditions should consult a healthcare professional before attempting it.
Can BPPV come back after the Epley maneuver?
Yes. BPPV can recur after successful treatment, and some patients may require another repositioning treatment.
Can the Epley maneuver treat all types of vertigo?
No. The Epley maneuver is designed for appropriate BPPV and does not treat every cause of vertigo or dizziness.
Where can I get BPPV treatment in Vadodara?
Bharti ENT Care has a dedicated Vertigo Clinic in Vadodara and specifically lists BPPV among the conditions it evaluates and treats. Its locations include Nizampura and Gotri.
