Canalith repositioning procedure, Epley maneuver

Overview

The canalith repositioning procedure (CRP), commonly known as the Epley maneuver, is a non-invasive treatment for Benign Paroxysmal Positional Vertigo (BPPV), the leading cause of vertigo. This procedure involves specific head movements designed to relocate the canaliths, alleviating vertigo symptoms.

BPPV is a condition that produces acute, fleeting dizziness and spinning sensations. It could happen when turning the head. Usually, an issue with the portion of the inner ear that controls balance is the cause of vertigo. BPPV happens when microscopic canalith particles, also known as otoconia, in a certain inner ear segment come loose and shift. This may create vertigo and make one more sensitive to movement.

The Epley maneuver entails a sequence of head movements designed to shift calcium carbonate crystals from the utricle to the semicircular canals, restoring their proper position. It can be self-administered at home, but it is advisable to first seek guidance from a healthcare provider to ensure correct technique and safety.

The canalith repositioning procedure is often successful, relieving vertigo in about 80% of people after one or two treatments. However, there is a chance the problem may come back. And while effective for BPPV, it does not address other types of vertigo.

Reasons for undergoing the procedure

BPPV occurs when small calcium crystals in the inner ear, called canaliths or otoconia, dislodge and enter the semicircular canals, leading to vertigo. The canalith repositioning procedure helps ease symptoms of BPPV by relocating the troublesome particles in the inner ear.

After a canalith repositioning procedure, many people feel immediate relief from BPPV symptoms, although sometimes multiple treatments may be needed for full relief. The Epley maneuver is often the first treatment recommended by healthcare providers for BPPV.

Risk

The canalith repositioning procedure carries some risks. Additionally, if the Epley maneuver is not performed correctly, it could result in adverse effects or worsening vertigo symptoms. To minimize these risks, it is advisable to have a healthcare provider demonstrate the correct technique before attempting it at home.

Before undergoing the procedure, it is also important to inform the healthcare provider about any existing medical conditions like neck or back issues, or advanced rheumatoid arthritis, as this might affect the procedure or require postponement.

Potential risks of canalith repositioning procedure include:

• Movement of the particles to a place where vertigo could persist
• Back and neck injuries
• Vomiting
• Nausea, dizziness and lightheadedness

Before the procedure

It is recommended to wear attire that facilitates unrestricted movement during the different positions required for the procedure.

During the procedure

The canalith repositioning procedure takes approximately five to 10 minutes to finish. The procedure may be repeated three or more times in one session. It is crucial to keep the head down and avoid lifting it during any part of the procedure. The healthcare provider will also observe the eyes for any unusual movements.

During the canalith repositioning procedure, one will hold four positions for around 30 seconds each, or until the symptoms subside. After the symptoms have stopped, one must remain in each position for about 30 more seconds.

The procedure is performed as follows:

• Transition from sitting to reclining with the head turned 45 degrees to the affected side
• Gradually move the head to the opposite side by about 90 degrees
• Lie on the side with the head tilted slightly down, facing the floor. Keep the body aligned with the head when turning.
• Return to a seated position with the head centered and tilted down. Remain seated quietly for around 15 minutes.

After the procedure

After canalith repositioning procedure, there are no specific instructions to follow, but it is advisable to avoid sudden head movements and refrain from bending over for the remainder of the day.

The healthcare provider may also provide instructions to perform the procedure at home if necessary. It might take several days of consistently doing these exercises before the symptoms fully subside.

Outcome

If symptoms continue after performing the Epley maneuver, it’s advisable to consult your healthcare provider for further advice. They may perform tests to exclude other conditions such as ear infections or migraines and might recommend medications like those for nausea or motion sickness to alleviate symptoms.

Typically, the Epley maneuver may need to be repeated several times to achieve symptom improvement. Numerous studies conducted over the years on canalith repositioning maneuvers have shown that this treatment is generally effective, providing relief for approximately 80% of individuals.