What Is Epley Maneuver?
Epley maneuver involves a series of head movements done to relieve the symptoms of benign paroxysmal positional vertigo.
The semicircular canal of the inner ear detects motion and sends the information to the brain. In BPPV, the calcium crystals (canaliths) from the utricle detach from there and ends up in the semicircular canals of the ear. These crystals in motion inside the utricle send incorrect signals to the brain and make wrong interpretations about your position. This makes you feel like the surrounding is spinning or the head is spinning, which is vertigo.
In the Epley maneuver, there are a series of movements done in order to dislodge the crystals from the semicircular canal. These head movements bring the canaliths back to the utricle whey they are supposed to be and hence resolve vertigo.
Epley maneuver is found to produce good results in 80 % of cases after one or two treatment sessions. But the problem can recur after some time of the treatment.
What Is Benign Paroxysmal Positional Vertigo?
Benign paroxysmal positional vertigo is a condition in which the patient will have vertigo. Vertigo is a feeling of being off-balance; that is, the patient will feel that the surrounding around him/her is spinning, which makes them difficult to balance even with slight movement. The other symptoms of Benign paroxysmal positional vertigo include dizziness, nausea, and vomiting. It is a condition that is caused by the dislodged calcium crystals from the utricle ending up in the semicircular canal. These crystals in the inner ear move inside that compartment whenever there is a slight movement of the head. The movement of these crystals sends the wrong signals to the brain, which affects the balance of the patient.
The main reason for this to happen is the degeneration of the vestibular system of the inner ear, which is seen in old-age patients. The other reason for BPPV in patients less than 50 years old could be a head injury or following surgery.
Diagnosis is usually made by taking detailed case histories of the patients and by physical examination. The BPPV usually does not require treatment as such, but for patients to have a sooner recovery, the Epley maneuver, also known as the canalith repositioning procedure, is carried out.
What Are the Indications?
Epley maneuver is done to relieve vertigo in Benign paroxysmal positional vertigo. In patients with BPPV, vertigo can occur during certain sudden head movements, and the Epley maneuver is done to reposition the canalith in the semicircular canal back to the utricle.
BPPV can often occur without any cause, but sometimes BPPV can be seen in the following cases:
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Following ear surgery.
What Are the Contraindications?
For the Epley maneuver, there are very few contraindications as such. However, the clinician must take into consideration the patient's anatomy and neck mobility. Patients with limited neck mobility will find it difficult to do this maneuver as this needs quick movements at the neck joint. In patients having cervical spinal stenosis or limited cervical mobility, the quick cervical spine rotation and hyperextension needed for the maneuver cannot be made. So in such patients, the Epley maneuver is contraindicated.
How Is It Done?
Epley maneuver is a series of head movements done. These positions are held for at least 30 seconds or longer till the patient experiences the symptoms; following the episode of having symptoms, the patient will have to stay in the same position for an extra 30 seconds more till the symptom subsides. The doctor will watch for abnormal eye movements during the procedure.
Epley maneuver is done in the following way:
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Lay down with the head towards the affected side by about 45 degrees. Then slightly extend your head over the edge of the table at a slight angle.
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In the lying down position, tilt your head towards the unaffected side by about 90 degrees.
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Roll your body to be in line with your head. The head should be slightly angled while you look at the floor.
Once the procedure is over in the clinic, follow the doctor's instructions. In some cases, doctors might instruct you to do this procedure at home by yourself if needed. You might need to perform this procedure for several days for the effects to be seen in the patient; in such cases home Epley maneuver might be advised by the doctor.
What Equipment Are Needed?
Epley maneuver is not a technique-sensitive procedure, so it does not need much equipment to carry out this procedure.
The pieces of equipment needed are:
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Examination table.
Other equipment and material which might be needed during the procedure are:
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Antiemetic drugs are used as a premedication.
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IV access equipment.
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Pillows for hyperextension of the neck.
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Emesis bag.
The use of an antiemetic drug prior to the procedure will provide comfort and temporary relief from nausea for the patient.
What Risks Are Involved in This Procedure?
Epley maneuver, also known as the canalith repositioning procedure, involves certain risks, which are mentioned below:
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Neck or back injury.
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Repositioning the canalith in an inappropriate place may worsen the condition or may not relieve the symptoms.
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Has side effects such as nausea, dizziness, and lightheadedness.
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Intense vertigo symptoms.
Patients need to inform the doctor of their prior medical condition before the start of the procedure.
What Is the Result From Epley Maneuver?
In the majority of cases, the Epley maneuver is found to be an effective treatment for Benign paroxysmal positional vertigo. In some cases, the symptoms might reappear; in such cases, the procedure needs to be repeated several times until the symptom is relieved.
Conclusion
Epley maneuver is a low-cost and benign treatment option for Benign paroxysmal positional vertigo, and one might need to carry out the procedure multiple times to obtain results. Even though BPPV does not require treatment in the majority of cases but in some cases, it affects normal functioning. In such cases, for faster recovery from the symptoms Epley maneuver is performed. In the Epley maneuver, the patient is made to do certain head movements so as to bring back the displaced crystals in the inner ear. In case you or your dear ones suffer from BPPV, consult a doctor sooner for an early diagnosis to get proper treatment and hence relief from the symptoms as early as possible.
