Vestibular First

🥇The modified Epley Maneuver is THE gold-standard treatment for posterior canalithiasis BPPV, the most common form of episodic positional vertigo.

💎Why use the term “modified?” This familiar version is actually an update to Dr. John Epley’s original version from the 1980’s. His version used vibration over the mastoid on the affected side and restrictions in postures/positions after the treatment, both of which have since been proven unnecessary (they do not improve outcomes).

📊 EFFECTIVENESS: Resolves posterior canal BPPV in ~80–90% of patients within 1–3 treatments. It carries a “Level A” recommendation in the Clinical Practice Guideline for BPPV (Bhattacharyya et al., 2017). BPPV recurrence is ~10–30% within a year, especially with risk factors like older age, history of head trauma, osteoporosis, migraine history, high blood pressure, diabetes, and/or low vitamin D levels.

📝 STEP-BY-STEP PROTOCOL (LEFT EAR): A clinician assesses, guides, and assists the patient throughout.

✅Starting Position: Patient in long sitting (legs out).

1. Turn head 45° toward the affected (left) side.

2. Lie back quickly, extending the neck 20–30° over the edge of the table or over a pillow. Hold until nystagmus stops plus ~20 sec.

3. Rotate head 90° toward the unaffected (right) side. Hold until nystagmus stops plus ~20 sec.

4. Roll body and head a further 90° into right side-lying, face angled downward toward the table. Hold until nystagmus stops plus ~20 sec.

5. Return to sitting on the edge of the table, keeping your head turned and chin tucked toward your chest (CHIN TUCKED DOWN IS ESSENTIAL). Maintain this position for ~1 minute, then slowly center the head at the midline and neutral position.

6. Repeat if needed.

🎁 v1st.co/epleyhandout for a FREE printable pdf of the (modified) Epley maneuver!

⚠️ Always consult a qualified vestibular specialist before attempting any BPPV maneuvers. Educational purposes only.

👑Post created in collaboration with Sonia Vovan, PT, PhD(c) ().