Epley manoeuvre

Figure 1.1 Performance of the therapeutic canalith repositioning procedure for right-sided posterior canal BPPV ( from Bhattacharyya, 2017, adapted and reproduced with permission from Fife et al. 2008)

1. The patient is placed in the upright position with the head turned 45 degrees toward the affected ear (the ear that was positive on the Dix-Hallpike testing).
2. The patient is rapidly laid back to the supine head-hanging position, which is then maintained for 20 to 30 seconds (added by the guideline working group: but longer if the nystagmus persists and until the nystagmus disappears).
3. Next, the head is turned 90 degrees toward the other (unaffected) side and held for about 20 seconds.
4. Following this rotation, the head is turned a further 90 degrees (usually necessitating the patient’s body to also move from the supine position to the lateral decubitus position) such that the patient’ head is nearly in the facedown position. This position is also held for 20 to 30 seconds.
5. The patient is then brought into the upright sitting position, completing the maneuver.