Epley maneuver or Epley manoeuvre?
They are the same treatment. Manoeuvre is the British spelling and maneuver the American one. It is named after Dr John Epley, the American ear specialist who developed it, and is also called a canalith repositioning procedure. It treats BPPV only, the most common cause of brief spinning vertigo when you turn over in bed or look up. See what BPPV is.
What it involves
You sit on a couch with your head turned 45 degrees towards the affected ear. The clinician lies you back quickly with your head slightly over the end of the couch, holding that position for 30 to 60 seconds, during which vertigo is often provoked. Your head is then turned 90 degrees to the other side, held again, then you roll onto that side with your head turned further so you are looking at the floor, held again, and finally sit up. Each position lets the crystals fall a little further along the canal until they exit into the chamber where they are harmless.
Does the Epley manoeuvre work?
Trials and reviews show the Epley resolves BPPV in around 80 per cent of people after a single treatment and more than 90 per cent after two, compared with a much slower natural recovery. It is recommended as first-line treatment in NHS, NICE and international guidance. When it does not work, the usual reasons are that it was done on the wrong side, the crystals are in a different canal that needs a different manoeuvre, or the dizziness is not BPPV. BPPV can also return months or years later; see whether BPPV can come back.
Is there an Epley test? Why the test comes first
There is no separate Epley test. When people search for one, they usually mean the Dix-Hallpike test, a quick positional test that provokes the vertigo and the typical eye movements of BPPV. The manoeuvre only works if it is done for the right ear and the right canal. The Dix-Hallpike test identifies both. Doing the Epley on the wrong side does nothing, and a different canal needs a different manoeuvre. See what happens at a vestibular assessment.
Doing it at home
Home versions exist and can work once the affected side has been confirmed by a clinician. Doing it blind, based on a video, is a common reason it fails. If you have had a clinician-guided Epley and BPPV recurs on the same side, a home repeat is reasonable. For the step-by-step home method, see Epley manoeuvre BPPV treatment at home.
Afterwards
Mild unsteadiness for a day or two is common as the brain readjusts. Keep the head upright for the rest of the day and avoid sudden movements. There is no need to sleep propped up, which older advice suggested.
When to get urgent help
Call 999 if dizziness comes with face drooping, arm or leg weakness, slurred speech, double vision, a sudden severe headache or difficulty walking, as these can be signs of a stroke. See a GP if vertigo lasts for days, keeps coming back, or comes with hearing loss or ringing in the ear.
At Omnia
Vestibular First at our Chiswick clinic performs the positional test and the Epley or the appropriate alternative in one appointment. Book a vertigo and BPPV assessment in Chiswick, including treatment, for £50. Omnia Lifestyle is at 8 to 9 Bedford Corner, The Avenue, Chiswick W4 1LZ, close to Turnham Green station, on bus routes 94, E3 and 272. Limited parking is available on request when booking.
Book a Vestibular First assessment in Chiswick: assessments from £50. Book online or call 020 4515 0000. Read more about vestibular rehabilitation at Omnia.