What is the Epley Maneuver?

How Vestibular Rehabilitation Therapists Use Canalith Repositioning Maneuvers (i.e. the Epley Maneuver) to Correct BPPV

There are many different treatments that vestibular rehabilitation therapists can provide to help with a wide variety of vestibular problems. One type of treatment includes performing maneuvers to correct Benign Paroxysmal Positional Vertigo (BPPV) which is one of the most common causes of brief vertigo or 'room spinning'.

The Epley Maneuver is a Specific Series of Head Positions Performed by a Medical Professional

A person suffering from BPPV will normally find that moving their head into certain positions causes brief vertigo, lasting about 30 seconds.  This is because otoliths (calcium carbonate crystals) that are no longer in the correct part of the inner ear, move with gravity and deflect hair cells which stimulate nerves to send false movement signals to the brain.  In maneuvers like the Epley Maneuver a medical professional moves your head slowly and carefully through a very specific series of positions.  This allows gravity to move the calcium carbonate crystals (otoconia) out of the part of the inner ear where they are not supposed to be, back into a place in the inner ear where they’ll no longer cause false signals and debilitating symptoms like vertigo. (Vestibular Disorders Association - VEDA)

It is very important to understand, however, that the Epley maneuver is only one of numerous canalith repositioning maneuvers and will ONLY work for certain variants of BPPV.  It is normally highly effective for the most common form of BPPV but if it isn’t working perhaps you have a different type of BPPV requiring a different maneuver, the maneuver isn’t being performed correctly, or maybe you don’t actually have BPPV at all.

Don't Try the Epley Maneuver By Yourself

Despite instructions being readily available on the internet, it is advisable to avoid performing the Epley maneuver on your own in most circumstances.  It is important for the diagnosis of BPPV to be confirmed by a medical professional who is specifically trained to do so, and they can also determine whether a patient is a candidate for a canalith repositioning procedure based on mobility and other medical conditions.  They can determine which variant of BPPV you have, which then dictates if the Epley maneuver is the appropriate treatment or whether a different canalith repositioning maneuver is required.   They would then proceed with helping you through the appropriate maneuver, so doing it on your own shouldn’t be required.  If the treatment isn’t immediately effective, the professional can help screen for other medical conditions that might make self-treatment unadvisable, and if deemed safe, they may teach you to do the maneuver on your own, however it is still recommended to do this under medical supervision instead for safety and effectiveness.

How Many Times Does It Take Before the Epley Maneuver Works?

According to the Vestibular Disorders Association, canalith repositioning procedures (like the Epley Maneuver) are very effective for BPPV, with an approximate cure rate of 80% and low recurrence rate (VEDA).  BPPV as the result of trauma may require more treatments to correct, however most people require just one treatment.  The vast majority of cases are corrected by 3 treatments, so if it seems to be requiring more, the following questions need to be asked:  Has the BPPV variant been identified correctly? Has the appropriate canalith repositioning maneuver been chosen?  Is it being performed correctly? And, could this be something other than BPPV?  A medical professional well-trained in vestibular disorders can help answer these questions.

Read about why it is so important to treat dizziness.

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7 Things That Can Go Wrong With Vestibular Information From One Ear

What Happens When the Brain Gets Abnormal Information Coming From One Ear?

It can be confusing for the brain when one inner ear is telling a different story that the other inner ear is telling

When the brain receives information about movement or position from one ear that doesn't match the other ear, error signals alert you that something is wrong. Many different things can affect the vestibular information from one side, such as:

1. Ear infections
2. Vascular changes
3. Tumors
4. Perilymphatic Fistula (a small hole that can occur in the labyrinth)
5. A concussion or other trauma affecting only one labyrinth
6. Mechanical problems like BPPV. Benign Paroxysmal Positional Vertigo, which is common especially among older adults, is the most common cause of a false sensation of spinning (vertigo).
7. Alterations in fluid pressure in one labyrinth like Endolymphatic Hydrops/Meniere's disease

What Happens When Fluid Pressure Shifts in the Inner Ear?

With conditions such as Meniere's disease or Endolymphatic Hydrops, fluid pressure can shift periodically in the inner ear. When the fluid balance is disturbed, the pressure in one ear can suddenly go awry. In this case you have a large mismatch of information coming to the brain that can be quite incapacitating.

Contact us at lifemarkvestibular.ca - we can help!

How We Help BPPV in Older Adults

BPPV a Common Cause of Dizziness in Seniors

BPPV happens when loose crystals (otoconia) fall out into one of the canals

One of the most common causes of dizziness in seniors is Benign Paroxysmal Positional Vertigo, or BPPV.  This happens when calcium carbonate crystals (otoconia), that we all have in one part of the inner ear, become displaced into one or more of the inner ear’s semicircular canals. When otoconia move into one of the inner ear’s semicircular canals where they aren’t supposed to be, that canal sends different information to the brain about certain head movement than the other ear.  Both ears should be saying the same thing about what our head movements are, and they should be agreeing with what our eyes are seeing and our joints are feeling.  When there is a mismatch in these systems, it makes us feel dizzy.  BPPV is the most common cause of vertigo, which is an illusion of the room spinning or moving.

What Happens in the Inner Ear When the Room Starts Spinning?

Taking apart what's really happening to a BPPV patients as they experience vertigo can help patients to feel less frightened by it. The start of the problem often happens at night when a person is laying down.  Loose crystals can fall out into one of the canals, and when the person gets up in the morning these crystals are trapped out in the canal.  From that point forward any time the person moves their head into a position where gravity moves the loose crystals, that canal sends a message to the brain that is an error.  The most commonly provoking movements are getting in or out of bed, rolling over in bed, bending, looking upward and quick head movements.

Because of the connections between our inner ears and our eye muscles, during the time the crystals are moving, the incorrect signal makes our eyes move in a way that makes it appear like the room is spinning.  In the most common form of BPPV, the spinning only lasts until the crystals stop moving because they’ve reached the lowest point in the canal, which takes less than 1 minute.  If things are spinning longer than 1 minute, it is either a rarer form of BPPV called cupulolithiasis, or it is a condition other than BPPV.  A well-trained Vestibular Rehabilitation Therapist, ideally using special goggles allowing for a magnified look at your eye movements, can help you determine whether or not you have BPPV, and if so, what form you’ve got and what canal the loose crystals have moved into.  This then determines the treatment maneuver that should be used.

How We Treat Bening Paroxysmal Positional Vertigo (BPPV)

To help sufferers of BPPV a vestibular rehabilitation professional uses techniques to locate the crystals that are out of place and employs maneuvers to reposition them back to the correct chamber with the help of gravity.  Typically after 1-3 visits peoples’ BPPV is corrected.   Sometimes people have some mild sensitivity to motion and/or some balance issues that persist after the BPPV is cleared, but these are typically easily remedied with some simple home exercises.

If you or anyone you know is experiencing dizziness or imbalance, feel free to contact us – we are here to help you!

Why Vestibular Rehab?

How Many People Experience Dizziness?

Dizziness is among the top three reasons why people see their doctors, and vestibular disorders can affect people of any age. Approximately 35% of Americans over age 40 have experienced a vestibular disorder.

80% of people over age 65 have experienced dizziness, and Benign Paroxysmal Positional Vertigo (BPPV) - when crystals get displaced into the semicircular canals - is responsible for at least 50% of dizziness in seniors. BPPV is also the most common vestibular disorder, and fortunately, the most straight-forward to treat.

People who go untreated for their dizziness problems may risk experiencing depression, anxiety and a higher chance of falling. In addition, if it's hard to get out of bed or move around without feeling dizzy, there is also a risk of becoming less physically active or not active at all.

Untreated dizziness problems can lead to isolation

Effects of Dizziness

Dizziness can lead to:

• increased fear of falling or increased risk of falling
• less mobility, which leads to isolation and deconditioning
• anxiety and depression
• increased memory and concentration issues
• less likelihood of experiencing positive outcomes in other areas of treatment

Sometimes people who are experiencing dizziness may adopt new ways of moving to try and avoid the feeling of dizziness or whirling. They might move very slowly or swivel their whole body instead of their head in order to look at something, or look down at the ground all of the time to try to get their bearings. But these patterns can give people headaches and muscle tension, and just tire them out that much more. Research shows that avoiding the sensation of dizziness at all costs, actually slows down recovery.

Vestibular Rehab is an Exercise-Based Approach

Vestibular rehabilitation therapy is an exercise-based approach that retrains the brain to process coordinated information from the vestibular system, proprioception, and vision.

Research shows that Vestibular Rehabilitation is:

• applicable to anyone of any age
• effective regardless of how long a person has had the dysfunction
• has no reports of adverse effects

If you are dizzy or experiencing vertigo, please contact us for more information.