EPLEY MANOEUVRE PDF

The Epley maneuver or repositioning maneuver is a maneuver used by medical professionals to treat one common cause of vertigo , benign paroxysmal positional vertigo BPPV [1] [ needs update ] of the posterior or anterior canals of the ear. John Epley and first described in A version of the maneuver called the "modified" Epley does not include vibrations of the mastoid process originally indicated by Epley, as they have since been shown not to improve the efficacy of the treatment. The Epley maneuver is a safe and effective treatment for BPPV, though the condition recurs in around one third of cases.

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Jump to navigation. Benign paroxysmal positional vertigo BPPV is caused by a rapid change in head movement. The person feels they or their surroundings are moving or rotating. Common causes are head trauma or ear infection. BPPV can be caused by debris in the semicircular canal of the ear, which continues to move after the head has stopped moving.

This causes a sensation of ongoing movement that conflicts with other sensory information. The Epley manoeuvre is a treatment that is performed by a doctor or other health personnel with appropriate training, e. It is understood to work by moving the canal debris out of the semicircular canal. This linked video demonstrates how the Epley manoeuvre is performed. We included 11 studies in the review , with a total of participants. Five studies patients compared the efficacy of the Epley manoeuvre against a sham manoeuvre, three against other particle repositioning manoeuvres Semont, Brandt-Daroff and Gans and three with a control no treatment, medication only, postural restriction.

Patients were treated in hospital otolaryngology ear, nose and throat departments in eight studies and family practices in two studies. All patients were adults aged 18 to 90 years old, with a sex ratio of For resolution of vertigo the Epley manoeuvre was significantly more effective than a sham manoeuvre or control.

None of the trials that compared Epley versus other particle repositioning manoeuvres reported vertigo resolution as an outcome. When studies looked at the conversion from a positive to a negative Dix-Hallpike test a test to diagnose BPPV in the patients, the results significantly favoured the Epley treatment group when compared to a sham manoeuvre or control.

There was no difference when Epley was compared with the Semont or Gans manoeuvre. In one study a single Epley treatment was more effective than a week of three times daily Brandt-Daroff exercises. Adverse effects were not often reported. There were no serious adverse effects of treatment. Rates of nausea during the repositioning manoeuvre varied from Some patients were unable to tolerate the manoeuvres because of cervical spine neck problems.

The review of trials found that the Epley manoeuvre is safe and effective in the short term. Other specific sequences of physical movements, the Semont and Gans manoeuvres, have similar results.

There was a low risk of overall bias in the studies included. All trials were randomised, with five studies applying sealed envelope or external allocation techniques. Seven of the trials blinded the assessors to the patients' treatment group and data on all outcomes for all participants were reported in most studies. This evidence is up to date to January There is evidence that the Epley manoeuvre is a safe, effective treatment for posterior canal BPPV, based on the results of 11, mostly small, randomised controlled trials with relatively short follow-up.

Outcomes for Epley manoeuvre treatment are comparable to treatment with Semont and Gans manoeuvres, but superior to Brandt-Daroff exercises.

This is an update of a Cochrane Review first published in The Cochrane Library in Issue 1, and previously updated in and Benign paroxysmal positional vertigo BPPV is a syndrome characterised by short-lived episodes of vertigo in association with rapid changes in head position.

It is a common cause of vertigo presenting to primary care and specialist otolaryngology clinics. Current treatment approaches include rehabilitative exercises and physical manoeuvres, including the Epley manoeuvre. The date of the most recent search was 23 January Randomised controlled trials of the Epley manoeuvre versus placebo , no treatment or other active treatment for adults diagnosed with posterior canal BPPV including a positive Dix-Hallpike test.

The primary outcome of interest was complete resolution of vertigo symptoms. Secondary outcomes were conversion of a 'positive' Dix-Hallpike test to a 'negative' Dix-Hallpike test and adverse effects of treatment. We included 11 trials in the review with a total of patients. Five studies compared the efficacy of the Epley manoeuvre against a sham manoeuvre, three against other particle repositioning manoeuvres Semont, Brandt-Daroff and Gans and three against a control no treatment, medication only, postural restriction.

Patients were treated in hospital otolaryngology departments in eight studies and family practices in two studies. All studies were randomised with six applying sealed envelope or external allocation techniques. Eight of the trials blinded the assessors to the participants' treatment group and data on all outcomes for all participants were reported in eight of the 11 studies.

Complete resolution of vertigo. Complete resolution of vertigo occurred significantly more often in the Epley treatment group when compared to a sham manoeuvre or control odds ratio OR 4.

None of the trials comparing Epley versus other particle repositioning manoeuvres reported vertigo resolution as an outcome. Conversion from a positive to a negative Dix-Hallpike test significantly favoured the Epley treatment group when compared to a sham manoeuvre or control OR 9. There was no difference when comparing the Epley with the Semont manoeuvre two studies, participants or the Epley with the Gans manoeuvre one study , 58 participants.

In one study a single Epley treatment was more effective than a week of three times daily Brandt-Daroff exercises OR Adverse effects were infrequently reported.

Some patients were unable to tolerate the manoeuvres because of cervical spine problems. Study characteristics We included 11 studies in the review , with a total of participants. Key results For resolution of vertigo the Epley manoeuvre was significantly more effective than a sham manoeuvre or control. Quality of the evidence There was a low risk of overall bias in the studies included.

Authors' conclusions:. Search strategy:. Selection criteria:. Data collection and analysis:. We used the standard methodological procedures expected by The Cochrane Collaboration.

Main results:. Complete resolution of vertigo Complete resolution of vertigo occurred significantly more often in the Epley treatment group when compared to a sham manoeuvre or control odds ratio OR 4. Conversion of Dix-Hallpike positional test result from positive to negative Conversion from a positive to a negative Dix-Hallpike test significantly favoured the Epley treatment group when compared to a sham manoeuvre or control OR 9.

Adverse effects Adverse effects were infrequently reported. Health topics:. Don't show again. What role do you identify with the most? Patient or care giver. We are collecting information on visitors to our website to ensure Cochrane resources meet the needs of our users. Your data will be anonymised for processing, will be stored securely, and will not be shared with any third parties.

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The Epley manoeuvre for benign paroxysmal positional vertigo (BPPV)

Jump to navigation. Benign paroxysmal positional vertigo BPPV is caused by a rapid change in head movement. The person feels they or their surroundings are moving or rotating. Common causes are head trauma or ear infection.

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What's to know about the Epley maneuver?

Learn about our expanded patient care options for your health care needs. The home Epley maneuver is a type of exercise help that helps to treat the symptoms of benign paroxysmal positional vertigo BPPV. You can do this exercise at home. BPPV is caused by a problem in your inner ear. Your semicircular canals are found inside your ear. They detect motion and send this information to your brain. The utricle is a nearby part of the ear.

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The Epley maneuver is an exercise you can do at home to relieve dizziness caused by benign paroxysmal positional vertigo BPPV. BPPV is caused by a problem with the inner ear. Calcium crystals called canaliths can end up in the semicircular canals. If these crystals become dislodged and move around, they can cause the sensation that the world is spinning or moving, also known as vertigo. The Epley maneuver, however, can dislodge these crystals and remove them from the semicircular canals. The Epley maneuver is often effective for many patients with BPPV, especially in cases where certain head movements seem to trigger vertigo.

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Epley Maneuver

Timothy C. Hain, MD Page last modified: May 9, The Epley maneuver, named after Dr. John Epley, is both intended to move debris or "ear rocks" out of the sensitive part of the ear posterior canal to a less sensitive location. It is also sometimes called the "canalith repositioning maneuver" or CRP.

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