Treatment for BPPV, posterior canal, right side, Epley maneuver

By Marcello Cherchi, MD PhD

The Epley maneuver was first described by Dr. John Epley (Epley 1992), an otolaryngologist working in Portland, Oregon. This remains the most widely practiced maneuver for treating posterior canal BPPV.

The Figure below, from Kim and Zee (Kim and Zee 2014), depicts the right-sided Epley maneuver for treating benign paroxysmal positional vertigo (BPPV) involving the right-sided posterior canal.

Figure: Right-sided Epley maneuver for right-sided posterior canal BPPV. From Kim and Zee (2014).
Figure : Right-sided Epley maneuver for right-sided posterior canal BPPV. From Kim and Zee (Kim and Zee 2014).

The Epley maneuver for treating right-sided posterior canal BPPV can be described as follows:

  1. The patient begins in a neutral seated position, then turns the head 45 degrees toward the affected (right) side.
  2. The patient lies down such that the trunk is supine, but the head is hanging 30 degrees off the edge of the table, and the head is still rotated 45 degrees toward the affected (right) side. This position is maintained for 1 minute.
  3. The patient rotates the head toward the unaffected (left) side, ending in a position in which the head is 45 degrees off the midline, with the patient’s nose pointing toward the patient’s unaffected (left) side half-way between the earth’s surface and the sky. This position is maintained for 1 minute.
  4. The patient rotates the trunk 90 degrees toward the unaffected (left) side, maintaining the head rotated 45 degrees off the midline (with respect to the trunk), such that the patient’s nose is pointing toward the patient’s unaffected (left) side half-way between the earth’s surface and the ground. This position is maintained for 1 minute.
  5. The patient sits up.
  6. The patient tucks the chin toward the chest by about 20 degrees.

Epley maneuver, right posterior canal, videos

The Epley maneuver is one of the earliest maneuvers described, and has probably been scrutinized more than any other treatment for BPPV.  In the original study (Epley 1992) Epley premedicated patients with scopolamine and used bone vibration over the mastoid; most subsequent studies examined the maneuver (in the sense of a series of positions) without scopolamine and mastoid vibration, sometimes referring to this as a “modified Epley.”

The Epley has been studied in multiple prospective trials:

  • Without a control group (Mujeeb and Khan 2000; Richard et al. 2005).
  • Against no treatment (Sherman and Massoud 2001; Wolf et al. 1999; Yimtae et al. 2003).

The Epley has been studied in multiple prospective randomized trials:

  • Against a sham maneuver (Chang et al. 2004; Froehling et al. 2000; Lee et al. 2014; Munoz et al. 2007; Sherman and Massoud 2001; Simhadri et al. 2003; von Brevern et al. 2006).
  • Against the Brandt-Daroff maneuver (Celis-Aguilar et al. 2022; Cetin et al. 2018; Choi et al. 2020; Soto Varela et al. 2001).
  • Against the Semont maneuver (Celis-Aguilar et al. 2022; Lee et al. 2014; Sinsamutpadung and Kulthaveesup 2021; Soto Varela et al. 2001; Thakur et al. 2024).
  • Against a modified Semont maneuver (Radtke et al. 2004).
  • Against the Gans maneuver (Dhiman et al. 2023; Saberi et al. 2017).
  • Against the Foster maneuver (Foster et al. 2012; Khaftari et al. 2021).
  • In supervised treatment versus self-treatment (Gan et al. 2021; Tanimoto et al. 2005).

Variations of the Epley maneuver have also been studied in multiple prospective randomized trials:

  • Against the regular Epley maneuver (Cohen and Kimball 2004).
  • Against the modified Semont maneuver (Cohen and Jerabek 1999).

The Epley maneuver has also been studied in multiple systematic reviews and meta-analyses (Hilton and Pinder 2002, 2004; Hilton and Pinder 2014; Hunt et al. 2012; Reinink et al. 2014; Saishoji et al. 2023; Teixeira and Machado 2006; Valsted et al. 2024; White et al. 2005; Woodworth et al. 2004).

References

 

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Cetin YS, Ozmen OA, Demir UL, Kasapoglu F, Basut O, Coskun H (2018) Comparison of the effectiveness of Brandt-Daroff Vestibular training and Epley Canalith repositioning maneuver in benign Paroxysmal positional vertigo long term result: A randomized prospective clinical trial. Pak J Med Sci 34: 558-563. doi: 10.12669/pjms.343.14786

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Choi SY, Cho JW, Choi JH, Oh EH, Choi KD (2020) Effect of the Epley Maneuver and Brandt-Daroff Exercise on Benign Paroxysmal Positional Vertigo Involving the Posterior Semicircular Canal Cupulolithiasis: A Randomized Clinical Trial. Front Neurol 11: 603541. doi: 10.3389/fneur.2020.603541

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Page first published on February 24, 2025. Page last updated on April 9, 2025

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