Dec 2, 2017 - FauquierENT.net - Video demonstrates how the Half-Somersault. This maneuver is considered an alternative to the Epley maneuver and is. Rating is available when the video has been rented. This feature is not available right now. Please try again later. Published on Mar 15, 2015.

Epley-CRP maneuver for BPPV The Epley Maneuver (Canalith Repositioning Procedure) for For practitioners. Page last modified: January 30, 2019 The positions of the Epley maneuver. Positions 1-4 correspond to positions B-E. The Epley maneuver, named after Dr. John Epley, is both intended to move debris or 'ear rocks' out of the sensitive part of the ear (posterior canal) to a less sensitive location.

It is also sometimes called the 'canalith repositioning maneuver' or CRP. The Epley maneuver takes about 15 minutes to complete.

It has a cure rate of roughly an 80% cure rate, the first time it is applied ( Herdman et al, 1993; Helminski et al, 2010). Others don't do as well however, and Hughes et al reported only a 47% cure rate the first time (Hughes et al, 2015).

It took them 3 maneuvers to get to 84% cure. The Epley consists of sequential movement of the head into four positions (positions B-D), staying in each position for roughly 30 seconds. The positions of the Epley are illustrated in figure 1. According to Kahraman et al, 2017, there is no difference in success rate between short maneuvers (i.e. 15 seconds in each position) and long maneuvers (i.e. 120 sec in each position). Nevertheless, we think it is more logical to use short duration for strong nystagmus, and longer duration for weak nystagmus or refractory cases.

Here are some movies: • • Supplemental material on the: Animation of. Note that this maneuver is done faster in the animation than in the clinic. Usually one allows 30 seconds between positions. If one can observe the eyes, as shown in a recording in the figure above, there should be a burst of upbeating/torsional nystagmus for at least positions B (the conventional Dix-Hallpike position), and D (the 180 degree from DH position). There may not be much nystagmus in position B (2) When performing the Epley maneuver, caution is advised should neurological symptoms (for example, weakness, numbness, visual changes other than vertigo) occur.

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Occasionally such symptoms are caused by compression of the vertebral arteries (Sakaguchi et al, 2003), and if one persists for a long time, a stroke could occur. If the exercises are being performed without medical supervision, we advise stopping the exercises and consulting a physician.

If the exercises are being supervised, given that the diagnosis of BPPV is well established, in most cases we modify the maneuver so that the positions are attained with body movements rather than head movements. After the Epley, you should provide your patient with the instructions below, which are aimed at reducing the chance that debris might fall back into the sensitive back part of the ear. INSTRUCTIONS FOR PATIENTS AFTER OFFICE TREATMENTS (Epley or Semont maneuvers) 1.

Wait for 10 minutes after the maneuver is performed before going home. This is to avoid 'quick spins,' or brief bursts of vertigo as debris repositions itself immediately after the maneuver. Don't drive yourself home. Sleep semi-recumbent for the next night. This means sleep with your head halfway between being flat and upright (a 45 degree angle). This is most easily done by using a recliner chair or by using pillows arranged on a couch (see figure 3).

During the day, try to keep your head vertical. You must not go to the hairdresser or dentist. No exercise which requires head movement. When men shave under their chins, they should bend their bodies forward in order to keep their head vertical. If eye drops are required, try to put them in without tilting the head back. Shampoo only under the shower. Some authors suggest that no special sleeping positions are necessary (Cohen, 2004; Massoud and Ireland, 1996).

We, as do others, think that there is some value (Cakir et al, 2006) 3. For at least one week, avoid provoking head positions that might bring BPPV on again. • Use two pillows when you sleep. • Avoid sleeping on the 'bad' side.

• Don't turn your head far up or far down. Be careful to avoid head-extended position, in which you are lying on your back, especially with your head turned towards the affected side.

This means be cautious at the beauty parlor, dentist's office, and while undergoing minor surgery. Try to stay as upright as possible. Exercises for low-back pain should be stopped for a week. No 'sit-ups' should be done for at least one week and no 'crawl' swimming. (Breast stroke is OK.) Also avoid far head-forward positions such as might occur in certain exercises (i.e. Touching the toes).