Epley maneuver

The Epley maneuver is a method of treating benign positional vertigo . It was first described by John M. Epley (1930-2019) in 1992 under the name Canalith Repositioning Procedure (CRP) . The aim of the maneuver is to use a sequence of defined movements to move the otoliths on which the disease is based out of the semicircular canals of the inner ear with the aid of gravity . The effectiveness has been proven in several studies. The sequence of movements proposed by Epley has since been modified by other authors.

description

It involves several consecutive 90 ° rotations of the head around different axes, each in a semicircular canal plane:

First, the patient sits on the examination table and turns his head 45 ° to the affected side. Then he quickly lays back 90 ° and also lowers his head by up to 30 ° over the rear edge of the bed (a slight overstretching is generally sufficient). The patient is now lying on his back with the affected ear down. The examiner can observe a nystagmus .

After the patient remains in this position for about a minute, he then turns his head 90 ° to the opposite side and remains in this position for another minute. Then he turns the body and head together again by 90 ° to the side of the head, so that the view is now directed downwards. The last two turns will result in nystagmus in the affected, overhead ear if the maneuver is successful. Now the patient lies on the unaffected side with the sound ear facing the floor.

After another minute of waiting, the patient straightens up completely (without first returning to the supine position) and at the end of the maneuver sits on the side edge of the couch.

In about half of the patients, just one application leads to freedom from symptoms. Sometimes it is recommended to perform the maneuver three times a day, where it is sufficient to stay in each position for 30 seconds.

Rapid movement of the head in space is important for the success of the treatment. All other movements can be done slowly. Contrary to the original description by Epley, an additional vibration on the mastoid does not improve the success of the treatment.

Web links

Videos for performing the Epley maneuver:

• Epley maneuver right
• Epley maneuver left

Individual evidence

1. ↑ John M. Epley MD.Retrieved May 1, 2020 . 
2. ↑ John M. Epley: The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo . In: Otolaryngol Head and Neck Surgery . 107 (3), 1992, pp. 399-404. PMID 1408225 .
3. ↑ Lynn et al. 1995, Steenerson et al. Cronin 1996, Asawavichianginda et al. 2000, Froehling et al. 2000, Sherman et al. Massoud 2001, Angeli et al. 2003, Simhadri et al. 2003, Yimtae et al. 2003, Chang et al. 2004
4. ↑ ^{a b} Description and illustration of a modified positioning maneuver according to Epley in the Hessisches Ärzteblatt from January 2007 , p. 16, accessed in May 2016
5. ↑ Description ( Memento of the original from June 8, 2016 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. and illustration of the Epley maneuver modified according to Brandt, Clinic for Clinical Neurophysiology of the University Medical Center Göttingen, accessed in May 2016  
6. ↑ Hain et al. 2000, Macias et al. 2004