Epley canalith repositioning manoeuvre
First-line treatment for posterior canal BPPV. Single-session success rate approximately 80%.
Indication
Confirmed posterior canal BPPV on Dix-Hallpike (characteristic upbeating-torsional nystagmus on the affected side).
Procedure
Step 1 of 5Sit upright, head rotated 45° to affected side
Start as for Dix-Hallpike — patient seated, head turned 45° to the affected side.
Expected finding
Successful repositioning resolves the patient's symptoms and abolishes the Dix-Hallpike response when re-tested. Brief residual symptoms over 24–48 hours are normal. If symptoms persist or recur, repeat the manoeuvre — multiple sessions can be required.
After-care
The 2017 AAO clinical practice guideline makes a strong recommendation AGAINST post-procedure postural restrictions (e.g. avoiding lying flat, sleeping upright, no head-down positions). These restrictions do not improve outcomes and are uncomfortable. The patient may resume normal activities immediately.
Cautions
- Cervical instability or recent cervical fracture.
- Severe cervical osteoarthritis — modify the angle or use the alternative Semont manoeuvre.
- Recent retinal detachment surgery or severe glaucoma — discuss with ophthalmology before head-down manoeuvres.
References
- Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T, et al. (2017). Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngology — Head and Neck Surgery, 156(3 Suppl):S1–S47. link