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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How Can the Inner Ear Make Me Unsteady?

Helping You Understand the Inner Ear

The ear is for hearing isn't it? I've been told that it is involved in balance and that ear problems can make you unsteady. How does that work?

Inertia, Gravity and Otoconia - Detecting Our Head Movements and Positions

In addition to the hearing organ, the inner ear contains the vestibular apparatus, which detects all head movements and positions.  This apparatus includes organs that contain calcium carbonate crystals (otoconia, or “ear rocks”) in gel.  Sensory hairs poke into the gel, so when the weight of the crystals shifts the gel due to linear acceleration, deceleration or tilt, the hairs get deflected.  These hairs are attached to nerve endings, so when they get moved, a signal is relayed to the brain telling us about what sort of motion is taking place and what orientation the head is at with respect to gravity.  The brain then uses this information to orient our eye position so that we can see clearly, and to tell our bodies what adjustments to make in order to keep our balance.

So if you are stopping or starting at a light, beginning to going up or down in an elevator, rocking on a boat, or just tilting your head and body a little, you can thank this part of the inner ear for helping you understand what is happening.   If these organs are not working properly in one or both ears, then you won’t be getting accurate information about your head position or certain head movements, in which case it’s pretty easy to see how this could make a person feel unsteady!  If your inner ear(s) aren’t telling you accurately where upright is, and if this information isn’t matching what your eyes see or your body feels, then you will likely feel off-balance.   (The inner ear also contains organs that don’t rely on gravity but instead detect angular head movements.  Problems here can create dizziness and vertigo, and this area will be explained next time.)

Fortunately, well-trained vestibular rehabilitation therapists can help people compensate for inner ear problems and improve their balance and orientation.  If you or anyone you know is experiencing dizziness or imbalance, feel free to contact us – we are here to help you!  

You can also find out more information about the inner ear balance system at the Vestibular Disorders Association .