The patient may be instructed to be cautious of bending over, lying backward, moving the head up and down, or tilting the head to either side. During every step of this procedure, the patient may experience some dizziness.įollowing the treatment, the clinician may provide the patient with a soft collar, often worn for the remainder of the day, as a cue to avoid any head positions that may once again displace the otoconia. These steps may be repeated twice, for a total of three times during a procedure. The patient holds a sitting position for up to 30 seconds.Finally, the patient is slowly brought up to an upright sitting posture, while maintaining the 45-degree rotation of the head.The eyes should be observed immediately by the clinician for “secondary stage” nystagmus (this secondary stage nystagmus should be in the same direction as the primary stage nystagmus).Now the patient is looking downward at a 45-degree angle. Keeping the head and neck in a fixed position relative to the body, the patient rolls onto the shoulder, rotating the head another 90 degrees in the direction being faced.Then the patient's head is rotated 90 degrees in the opposite direction, so that the opposite ear faces the floor, while maintaining 30 degrees of neck extension.The patient remains in this position for approximately 1–2 minutes.The clinician observes the patient's eyes for “primary stage” nystagmus.Then the patient is quickly lowered into a supine position (on the back), with the head held approximately in a 30-degree neck extension ( Dix-Hallpike position), with the head remaining rotated to the side.The patient begins in an upright sitting posture, with the legs fully extended and the head rotated 45 degrees toward the side in the same direction that gives a positive Dix–Hallpike test.The following sequence of positions describes the Epley maneuver: The modified procedure has become that now described generally as the Epley maneuver.Īn Epley maneuver is a safe and effective treatment for BPPV, although the condition recurs in approximately one third of cases. Ī version of the maneuver called the "modified" Epley does not include vibrations of the mastoid process originally indicated by Epley, as the vibration procedures have been proven ineffective. The maneuver was developed by the physician, John M. The maneuver works by allowing free-floating particles, displaced otoconia, from the affected semicircular canal to be relocated by using gravity, back into the utricle, where they can no longer stimulate the cupula, therefore relieving the patient of bothersome vertigo. 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. The doctor holds you in this position for 30 seconds.Maneuver used by medical professionals to treat one common cause of vertigo When your head is on the table, you are now looking down at the table. The doctor then quickly moves you to the other side of the table, without stopping in the upright position.The doctor holds you in this position for 30 seconds. When your head is on the table, you are looking up at the ceiling. The doctor then lowers you quickly to the side that causes the worst vertigo.The doctor turns your head so that it is halfway between looking straight ahead and looking away from the side that causes the worst vertigo.First, you sit on the examination table with your legs hanging off the edge.When your head is firmly moved into different positions, the crystal debris (canaliths) causing vertigo moves freely and no longer causes symptoms. A single 10- to 15-minute session usually is all that is needed. The Semont manoeuvre is done with the help of a doctor or physiotherapist.
The doctor will then help you to sit back up with your legs hanging off the table on the same side that you were facing.