Benign Paroxysmal Positional Vertigo (BPPV) is a common condition causing sudden, brief episodes of dizziness or vertigo. This happens when tiny calcium carbonate crystals, called otoconia or canaliths, dislodge from their normal position in the utricle and migrate into the fluid-filled semicircular canals of the inner ear. The Epley maneuver, also known as the canalith repositioning procedure, is a widely used, non-invasive treatment. It involves specific head movements designed to guide these displaced crystals back to the utricle, alleviating vertigo symptoms by stopping confusing signals to the brain.
When Relief Can Be Expected
Many individuals experience immediate relief from vertigo symptoms following a single Epley maneuver. However, full resolution often requires several repetitions or multiple sessions over days or weeks. Studies indicate many patients achieve symptomatic control after one to three maneuvers. The maneuver can be repeated daily for up to two weeks until symptoms subside.
Even after vertigo subsides, some individuals may experience “residual dizziness,” a feeling of unsteadiness, lightheadedness, or imbalance. This residual dizziness differs from acute vertigo and often results from the brain adjusting to the sudden absence of disorienting signals. This sensation typically resolves on its own, with one study noting it lasted an average of 16.4 days.
What Influences the Outcome
The effectiveness and speed of relief from the Epley maneuver are influenced by several factors. Proper technique is important, as incorrect movements can make it ineffective or even shift crystals to a different canal, potentially worsening symptoms. While the Epley maneuver is effective for BPPV affecting the posterior semicircular canal (the most common type), it is not suitable for crystals dislodged in the horizontal or anterior canals. Other specific maneuvers exist for these less common variations.
The duration of symptoms before treatment also plays a role; chronic BPPV sometimes requires a longer time to respond fully. Individual responses vary, so some people may need more sessions to achieve complete relief. Adherence to post-maneuver precautions, like avoiding sudden head movements or certain sleeping positions, may contribute to success, though the necessity of such restrictions is debated among experts.
Next Steps If Symptoms Continue
If vertigo symptoms persist, worsen, or do not respond to the Epley maneuver after several attempts, consulting a healthcare professional is advisable. This includes doctors, audiologists, or physical therapists specializing in vestibular rehabilitation. Persistent dizziness could indicate that BPPV crystals are in a different semicircular canal, requiring an alternative repositioning maneuver. It is also possible that symptoms are caused by another underlying condition not related to BPPV.
An accurate diagnosis is important for appropriate treatment. A vestibular rehabilitation therapist can perform specific tests to identify the exact cause of dizziness and develop a tailored exercise program. These programs often include exercises to improve balance and reduce dizziness, even if the Epley maneuver was not successful, by helping the brain adapt to any remaining issues.