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.
How effective it is
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.
Why the test comes first
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.
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.
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.
At Omnia
Vestibular First at our Chiswick clinic performs the positional test and the Epley or the appropriate alternative in one appointment.