How is the Epley procedure performed in the treatment of benign paroxysmal positional vertigo (BPPV)?

Updated: Feb 15, 2018
  • Author: John C Li, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

The Epley procedure is as follows (patient with right-sided BPPV in this example):

  • Starting position (sitting, head turned 45° toward ipsilateral side): The patient begins the procedure in a sitting position with the head turned toward the affected side. A mastoid bone oscillator is applied and held in position behind the affected ear by a headband to help agitate the particles so that they move more easily.

  • Position 1 (supine, head turned 45° toward ipsilateral side): The patient is reclined slowly to the supine position of the affected side. The rate is titrated to the point of no nystagmus and no symptoms. This usually takes approximately 30 seconds.

  • Position 2 (supine, 15° Trendelenburg, head turned 45° toward ipsilateral side): The patient is reclined further to the Dix-Hallpike position of the affected side. This usually takes 10 seconds. Another 20 seconds are spent in the Dix-Hallpike position with the affected ear down.

  • Position 3 (supine, 15° Trendelenburg, head turned 45° toward contralateral side): Next, the patient's head is turned slowly from position 3 toward the opposite side.

  • Position 4 (lying on side with contralateral shoulder down, head turned 45° below horizon toward contralateral side): The body is rolled so that the shoulders are aligned perpendicularly to the floor, affected ear up. The head is then turned farther so that the nose points 45° below the plane of the horizon. This usually takes another 40 seconds.

  • Position 5 (sitting, head turned at least 90-135° toward contralateral side): The patient is raised back to the sitting position with the head turned away from the affected side.

  • Ending position: Finally, the head is turned back to the midline. The mastoid bone oscillator is turned off, and the headband is removed.

A Dix-Hallpike test is performed immediately following the procedure. If nystagmus is observed, the procedure is repeated. After the procedure, the patient is instructed to avoid agitation of the head for approximately 48 hours while the particles settle and to return in 1 week for a follow-up examination.


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