The Epley Maneuver for BPPV Particle Repositioning

Many people with dizziness or vertigo have heard of the “Epley maneuver” as a treatment.

The Epley maneuver is used to reposition BPPV crystals.

It is the first procedure of its kind, published in the early 90’s by the late US-based physician named, John Epley. Since then, many healthcare providers and vertigo researchers around the world have developed a whole catalog of additional “particle repositioning maneuvers.”

In this blog, I discuss the top five reasons why the Epley maneuver may not be effective for BPPV treatment.

Incorrect Technique

First of all, many providers who are “dabbling” in vertigo care perform the maneuver incorrectly.

The Epley maneuver, the modified Epley, and all the particle repositioning maneuvers for BPPV require very precise, technically accurate performance to be effective. Unless the provider has studied the technique to reproduce precision and accuracy, they may be performing the Epley maneuver incorrectly.

In teaching this maneuver and other particle repositioning treatments to other providers, I have discovered certain predictable errors that are made by beginners. Those errors will reduce the effectiveness of the treatment.

Treating the Wrong Ear

Secondly, you have to treat the correct ear in order for the Epley maneuver to work.

The first step to effectively treating BPPV is to determine which ear is involved.

The options are right ear, left ear, or both ears. This can be determined through BPPV testing by a skilled provider.

I have been surprised how many times I have met a patient who described previous treatments to the “uninvolved ear” that obviously did not help at all, and in fact made them feel worse.

Treating the Wrong Semi-Circular Canal

There are three semi-circular canals in each inner ear. You must determine the canal that needs treatment.

The Epley maneuver is designed for the posterior canal.

If BPPV crystals are free-floating in the horizontal or anterior canal, then the Epley maneuver will not likely resolve the complaint.

Those other inner ear canals require different treatments that have been developed after the Epley maneuver was first published.

BPPV Crystals are Stuck

The BPPV particles can get stuck.

The Epley maneuver makes an assumption that the BPPV crystals are free-floating in the posterior canal of the ear being treated. However, there is a possibility that the BPPV crystals or debris can adhere to the sensory apparatus within the semi-circular inner ear canal called the “cupula.”

This is a type of BPPV called “cupulolithiasis,” as opposed to the more common “canalithiasis” with the free-floating crystals.

Cupulolithiasis is rare. In my experience treating literally thousands of people with BPPV, I have only found six people so far who have BPPV crystals stuck on their cupula.

It is possible to break the BPPV crystals off the cupula and resolve the problem, but starting with the Epley maneuver will not be effective in this case.

It’s not BPPV

The fifth reason that the Epley maneuver may not work is that you may not be dealing with BPPV.

There are other conditions that can mimic BPPV, even causing positional nystagmus and positional vertigo symptoms.

The five reasons I have listed above illustrate the importance of finding a skilled Vestibular provider to assess and treat your symptoms of dizziness, vertigo, and imbalance.

By doing this, the proper diagnosis can be assigned and the necessary care can be delivered effectively. You can get your life back!


This blog is provided for informational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.

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