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BPPV and Epley Maneuver

What is BPPV? (Quick Definition)

Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo. It is a disorder of the vestibular system, the balance organ located in the inner ear.

BPPV is caused by the displacement of tiny calcium carbonate crystals (called otoconia). These crystals detach from their normal position in the utricle and migrate into the semicircular canals of the inner ear. When these crystals are displaced, they create a disturbance in the fluid (endolymph) within the canal, sending erroneous signals to the brain.

This disorder presents as short episodes of intense vertigo (a spinning sensation) triggered by specific changes in head position, such as lying down, getting up, turning over in bed, or looking up or down.


The Different Canals

While BPPV most commonly affects the Posterior Canal (treated with the Epley Maneuver), the crystals can sometimes migrate into the Horizontal Canal (treated with the BBQ Roll Maneuver) or, less commonly, the Anterior Canal. A vestibular assessment is critical to correctly identify the affected canal.


The Epley Maneuver: Description and Goals


The Epley Maneuver, is a highly effective, non-invasive treatment primarily for Posterior Canal BPPV. It is a series of precise, sequenced head and body movements designed to move the displaced calcium crystals out of the semicircular canal where they are trapped and return them to the utricle, where they can be reabsorbed without causing symptoms.


Step-by-Step Description of the Epley Maneuver

Goal: To move the displaced crystals (otoconia) out of the posterior semicircular canal and back into the utricle.


1. Starting Position (Sitting)

  • The patient sits upright on the edge of the examination table with their legs extended.

  • The therapist rotates the patient's head 45 degrees toward the side of the affected ear.

2. Lying Back (Supine Head Hanging)

  • The patient is quickly and smoothly moved backward into a lying position (supine) with the head kept in the 45-degree rotation.

  • The head should extend slightly over the end of the table (or be supported such that the head is in slight extension), allowing gravity to move the crystals.

  • The position is held for at least 30 seconds (or until any resulting vertigo and nystagmus have completely stopped).

3. Head Rotation to the Opposite Side

  • While the patient remains lying on their back, the therapist rotates the head 90 degrees to the opposite side (the unaffected side). The head is now turned 45 degrees away from the affected side.

  • Example: Continuing from the right-ear example, the head is rotated from 45 degrees right to 45 degrees left.

  • This position is held for at least 30 seconds (or until any vertigo has subsided).

4. Body Roll and Head Rotation

  • The patient then rolls their body onto their side (the side of the unaffected ear). The head is kept in the same 45-degree rotated position.

  • At this point, the patient is looking down toward the floor at about a 45-degree angle. The chin should be tucked toward the shoulder.

  • This places the posterior canal so that the crystals move closer to the exit into the utricle.

  • This position is held for at least 30 seconds (or until any vertigo has subsided).

5. Sitting Up

  • The patient slowly returns to the upright seated position. The head should be kept in a neutral position (or slightly tucked) as they sit up.


Here is a video of the Epley maneuver




The BBQ Roll (Lempert) Maneuver: Role and Description

The Barbeque Roll (Lempert) Maneuver is the specific and highly effective treatment used when the displaced crystals are found in the Horizontal (or Lateral) Canal. The maneuver is designed to guide the displaced otoconia along the length of the horizontal canal and back into the utricle.


Description of the BBQ Roll Maneuver

This maneuver is named the "BBQ Roll" because it involves rolling the patient's head (and body) in sequential, 90-degree steps, mimicking a log or piece of food being turned on a barbeque rotisserie.

  • The patient lies on their back (supine).

  • The head is turned 90 degrees toward the unaffected ear.

  • The head is turned an additional 90 degrees so the patient is facing the floor (prone).

  • The head is turned another 90 degrees so the patient is lying on their unaffected side.

  • The patient sits up while keeping their head tilted toward the unaffected shoulder.

Each position is held for a duration (often 30 to 60 seconds) until any vertigo subsides, allowing the crystals to settle at the lowest point of the canal before the next sequential movement.


Here is a video of the BBQ roll:


 
 
 

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