![]() ![]() Since we first described this in 2021 we have completed this maneuver on a total of 15 patients. We essentially made position five include an extreme head tilt forward and skipped position 4 altogether.īelow is a demonstration of the modification for the right ear with the otoconia movements in red: Instead of going in to position 4, rolling the patient on their left side, we quickly sit the patient upright and have them point their nose downward, looking down toward their lap. In position 3 we turn the patients head toward the opposite side, once again with their head extended backward to the point that it is nearly upside down. In position 2 we keep the patients head nearly upside down with the head turned 45 degrees toward the affected side. The modification involves completing position 1,2 and 3 of the Epley maneuver as described above. Our Modification to the Epley Maneuver for BPPV ![]() It is worth noting that this patient also attempted another maneuver that didn’t require them to roll onto their side, the Half Somersault, both in office and at home without any change in symptoms. This modification to the Epley maneuver was successful in resolving the patient’s symptoms with one treatment and has been successful in alleviating several other patients’ symptoms since that time. This patient had right posterior canal BPPV and was unable to complete position 4 of the Epley maneuver due to recent shoulder surgery. We first described a case report of a modification that we made to the Epley maneuver for a patient with recent arthroscopic rotator cuff repair in 2021. The patient is then brought upright to a seated position (position 5).ĭespite the effectiveness of the Epley maneuver, some positions may be difficult for some patients to maintain. The patient then rolls onto their side, away from the affected ear, with their nose pointed downward toward the floor (position 4). After a period of around 30 seconds the head is then turned away from the affected ear toward the opposite shoulder with the head still tilted backward (position 3). The patient is then reclined backward into a supine position with their head turned 45 degrees toward the affected ear and with their head tilted backward (position 2). ![]() This maneuver requires the patient to turn their head 45 degrees toward the affected side while seated on a bed or exam table (position 1). The Epley maneuver is designed to treat the most common variant, posterior canal BPPV. ![]()
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