Treatment for BPPV, anterior canal, left side, reverse Epley maneuver

By Marcello Cherchi, MD PhD

The reverse Epley maneuver treats anterior canal benign paroxysmal positional vertigo (BPPV) (Bhandari et al. 2021; Korres et al. 2010).  Crevits (Crevits 2004) credits Honrubia and colleagues (Honrubia et al. 1999) with having first described the reverse Epley maneuver.  The reverse Epley maneuver It is less commonly used than other maneuvers for anterior canal BPPV. 

The Figure below, from Korres and colleagues (Korres et al. 2010), illustrates the reverse Epley maneuver for left anterior canal BPPV. This is identical to the regular (not reversed) Epley maneuver for the right posterior canal.

Figure: Reverse Epley maneuver for left anterior canal BPPV. From Korres et al. (2010).
Figure: Reverse Epley maneuver for left anterior canal BPPV. From Korres et al. (2010).

The description of the reverse Epley maneuver for treating left-sided anterior canal BPPV, adapted from Korres and colleagues (Korres et al. 2010), is as follows:

  1. The patient is sitting in a neutral position, and then turns the head 45 degrees toward the patient’s right (unaffected) side.
  2. The patient lies down, with the head hanging 30 degrees off the edge of the table, still turned 45 degrees toward the patient’s right (unaffected) side.
  3. The patient rotates the head toward the patient’s left (affected) side, achieving a position in which the patient’s head is rotated 45 degrees toward the patient’s left (affected) side, while still hanging 30 degrees below the level of the table.
  4. The patient rotates the body and head toward the patient’s left (affected) as far as is needed to achieve a position in which the patient’s nose is pointing 45 degrees between the earth’s surface and the ground.
  5. The patient is brought back up to a neutral seated position.

Confusingly, the Figure below, From Savas and colleagues (Savaş et al. 2024), is said to depict the reverse Epley maneuver for treating left-sided anterior canal BPPV, but it is the mirror image of the figure shown above. We believe the figure from Savas and colleagues is mistaken.

Figure: Supposedly the reverse Epley maneuver for left-sided anterior canal BPPV, from Savas et al. (Savaş et al. 2024). We believe this figure is mistaken.
Figure: Supposedly the reverse Epley maneuver for left-sided anterior canal BPPV, from Savas et al. (Savaş et al. 2024). We believe this figure is mistaken.

Reverse Epley maneuver, left anterior canal, videos

References

Bhandari A, Bhandari R, Kingma H, Strupp M (2021) Diagnostic and Therapeutic Maneuvers for Anterior Canal BPPV Canalithiasis: Three-Dimensional Simulations. Front Neurol 12: 740599. doi: 10.3389/fneur.2021.740599

Crevits L (2004) Treatment of anterior canal benign paroxysmal positional vertigo by a prolonged forced position procedure. J Neurol Neurosurg Psychiatry 75: 779-81.

Honrubia V, Baloh RW, Harris MR, Jacobson KM (1999) Paroxysmal positional vertigo syndrome. Am J Otol 20: 465-70

Korres S, Riga M, Sandris V, Danielides V, Sismanis A (2010) Canalithiasis of the anterior semicircular canal (ASC): treatment options based on the possible underlying pathogenetic mechanisms. Int J Audiol 49: 606-12. doi: 10.3109/14992021003753490

Savaş Ö, Cüreoğlu S, Güneri EA (2024) Benign Paroxysmal Positional Vertigo. In: Kalcioglu MT, Bayar Muluk N, Jenkins HA (eds) Neurotology Updates. Springer Nature Switzerland, Cham, pp 91-136

Page first published on February 24, 2025. Page last updated on March 8, 2025

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