Epley Maneuver - Exercises for Vertigo

Particle repositioning, Parnes, Agrawal, Atlas J

Epley maneuver – particle repositioning for benign paroxysmal positional vertigo (BPPV)

In Benign Paroxysmal Positional Vertigo (BPPV) dizziness is generally thought to be due to debris which has collected within a part of the inner ear
This debris can be thought of as “ear rocks”, although the formal name is “otoconia”
BPPV is a common cause of dizziness – about 20% of all dizziness is due to BPPV and while BPPV can occur in children the older you are, the more likely it is that your dizziness is due to BPPV – about 50% of all dizziness in older people is due to BPPV
The symptoms of BPPV include dizziness or vertigo, lightheadedness, imbalance, and nausea
Activities which bring on symptoms will vary among persons, but symptoms are almost always precipitated by movement – getting out of bed or rolling over in bed are common causes

The most common cause of BPPV in people under age 50 is head injury
There is also a strong association with migraine
In older people, the most common cause is degeneration of the vestibular system of the inner ear and BPPV becomes much more common with advancing age
Viruses affecting the ear such as those causing vestibular neuritis are significanct causes
Occasionally BPPV follows surgery, including dental work, where the cause is felt to be a combination of a prolonged period of supine positioning, or ear trauma
While rarely encountered, BPPV is also common in persons who have been treated with ototoxic medications such as gentamicin
In half of all cases, BPPV is called “idiopathic,” which means it occurs for no known reason

BPPV ear crystals

The Epley maneuver is also called the particle repositioning or canalith repositioning procedure – it was invented by Dr. John Epley, and is illustrated below
The Epley maneuver involves sequential movement of the head into four positions, staying in each position for roughly 30 seconds.
The recurrence rate for BPPV after these maneuvers is about 30 percent at one year, and in some instances a second treatment may be necessary

Epley maneuver

Wait for 10 minutes after the maneuver is performed before going home – this is to avoid “quick spins,” or brief bursts of vertigo as debris repositions itself immediately after the maneuver – don’t drive yourself home
Sleep with your head halfway between being flat and upright (a 45 degree angle) – this is most easily done by using a recliner chair or by using 2 or 3 pillows