Positional manoeuvres in benign positional vertigo

• Epley's manoeuvre (canalith repositioning procedure) (1)
  • been devised to remove debris from the semicircular canals and deposit it in the utricle where hair cells are not stimulated
  • vestibular sedatives, given one hour before Epley's manoeuvre, may be useful in severe cases.
  • Epley's manoeuvres consists of:
    • the Hallpike manoeuvre:
      • the patient is seated upright
      • the head is turned towards the affected side (say the left)
      • with the head still turned, the patient is reclined past the horizontal
      • hold for 30 seconds
    • in the reclined position the head is turned to the right
      • hold for 30 seconds
    • the patient is rolled onto their right side
      • the head is still turned to the right (the patients is now looking towards the floor)
      • hold for 30 seconds
    • the patient is sat upright, still look over their right shoulder
      • hold for 30 seconds
    • the patient turns the head to the midline with the neck flexed, chin down through 45 degrees
      • hold for 30 seconds
        
        
  • contraindications to canalith repositioning procedures include (1):
    • severe carotid stenosis
    • unstable heart disease
    • severe neck disease (cervical spondylosis with myelopathy)
    • advanced rheumatoid arthritis
      
  • Click here for video of Epley's manoeuvre
    
    
• Semont manoeuver (also called the liberatory maneuver) (2)
  • involves a procedure whereby the patient is rapidly moved from lying on one side to lying on the other.(2)
  • more difficult to perform and more uncomfortable for the patient than the Epley maneuver (3)
  • Click here for video of Semont manoeuvre

Reference:

• (1) Swartz R. Treatment of vertigo. Am Fam Physician 2005;71:1115-22, 1129-30
• (2) Benign paroxysmal positional vertigo.American hearing research foundation 2006
• (3) Furman JM, Cass SP. Benign paroxysmal positional vertigo. N Engl J Med 1999;341:1590