Ondansetron is the one we recommend for this as there is no sedation. Use of an antiemetic prior to the maneuver may be helpful if nausea is anticipated. We have not found this useful in a study of our patients (Hain et al, 2000). While some authors advocate use of vibration in the Epley maneuver, While we respect these authors, we still feel it best to follow the procedure recommended by Epley. Variant maneuvers for BPPV:Ĭomment: Massoud and Ireland (1996) stated that post-treatment instructions Year, and in some instances a second treatment may be necessary. The recurrence rate for BPPV after these maneuvers is about 30 percent at one Position yourself cautiouslyĪnd under conditions in which you can't fall or hurt yourself. The position that usually makes you dizzy. At one week after treatment, put yourself in Do not start doing the Brandt-Daroff exercises immediately or 2 daysĪfter the Epley or Semont maneuver, unless specifically instructed otherwiseĤ. (Breast stroke is OK.) Also avoidįar head-forward positions such as might occur in certain exercises (i.e. This meansīe cautious at the beauty parlor, dentist's office, and while undergoing minor Don't turn your head far up or far down.īe careful to avoid head-extended position, in which you are lying on yourīack, especially with your head turned towards the affected side.For at least one week, avoid provoking head positions that might bring BPPV on again. We, as do others, think that there is some value (Cakir et al, 2006)ģ.

No special sleeping positions are necessary (Cohen, 2004 Massoud and Ireland,ġ996). If eye drops are required, try to put them in without When men shave under their chins, they should bend their bodies forward in order No exercise which requires head movement. During the day, try to keep your head vertical. This is mostĮasily done by using a recliner chair or by using pillows arranged on a couch Head halfway between being flat and upright (a 45 degree angle). Of vertigo as debris repositions itself immediately after the maneuver. This is to avoid 'quick spins,' or brief bursts Wait for 10 minutes after the maneuver is performedīefore going home. INSTRUCTIONS FOR PATIENTS AFTER OFFICE TREATMENTS (Epley or Semont maneuvers)ġ. We modify the maneuver so that the positions are attained with body movementsĪfter the Epley, you should provide your patient with the instructionsīelow, which are aimed at reducing the chance that debris might fall back into Supervised, given that the diagnosis of BPPV is well established, in most cases Stopping the exercises and consulting a physician. If the exercises are being performed without medical supervision, we advise Occasionally such symptoms are caused by compression of the vertebralĪrteries (Sakaguchi et al, 2003), and if one persists for a long time, a stroke could occur. Symptoms (for example, weakness, numbness, visual changes other than vertigo) When performing the Epley maneuver, caution is advised should neurological There may not be much nystagmus in position C. If one can observe the eyes, as shown in a recording in the figure above, there should be a burst of upbeating/torsional nystagmus for at least positions B (the conventional Dix-Hallpike position), and D (the 180 degree from DH position). Usually one allows 30 seconds between positions. Note that this maneuver is done faster in the animation than in the clinic. Click here for a low bandwidth animation.The n ystagmus expected from an Epley maneuver is shown here: Nevertheless, we think it is more logical to use short duration for strong nystagmus, and longer duration for weak nystagmus or refractory cases. 15 seconds in each position) and long maneuvers (i.e. According to Kahraman et al, 2017, there is no difference in success rate between short maneuvers (i.e. The left ear is treated similarly but starts on the left side instead. The positions of the Epley for the right ear are illustrated Of the head into four positions (positions B-D), staying in each position for roughly 30 seconds. The Epley consists of sequential movement It has a cure rate of roughly an 80% cure rate, the first time it is applied ( Herdman et al, 1993 Helminski et al, 2010). The Epley maneuver takes about 15 minutes to complete. It is also sometimes called the 'canalith repositioning maneuver' or CRP. Or ' ear rocks' out of the sensitive part of the ear (posterior canal) John Epley, is both intended to move debris The positions of the Epley maneuver (R ear).

Epley vertigo maneuver