There are other conditions that can mimic BPPV, even causing positional nystagmus and positional vertigo symptoms. The fifth reason that the Epley maneuver may not work is that you may not be dealing with BPPV.
It is possible to break the BPPV crystals off the cupula and resolve the problem, but starting with the Epley maneuver will not be effective in this case. In my experience treating literally thousands of people with BPPV, I have only found six people so far who have BPPV crystals stuck on their cupula. This is a type of BPPV called “cupulolithiasis,” as opposed to the more common “canalithiasis” with the free-floating crystals.Ĭupulolithiasis is rare. However, there is a possibility that the BPPV crystals or debris can adhere to the sensory apparatus within the semi-circular inner ear canal called the “cupula.” The Epley maneuver makes an assumption that the BPPV crystals are free-floating in the posterior canal of the ear being treated. Those other inner ear canals require different treatments that have been developed after the Epley maneuver was first published. If BPPV crystals are free-floating in the horizontal or anterior canal, then the Epley maneuver will not likely resolve the complaint. The Epley maneuver is designed for the posterior canal. There are three semi-circular canals in each inner ear. You must determine the canal that needs treatment. I have been surprised how many times I have met a patient who described previous treatments to the “uninvolved ear” that obviously did not help at all, and in fact made them feel worse. This can be determined through BPPV testing by a skilled provider. The options are right ear, left ear, or both ears. The first step to effectively treating BPPV is to determine which ear is involved. Secondly, you have to treat the correct ear in order for the Epley maneuver to work. Those errors will reduce the effectiveness of the treatment. In teaching this maneuver and other particle repositioning treatments to other providers, I have discovered certain predictable errors that are made by beginners.
Unless the provider has studied the technique to reproduce precision and accuracy, they may be performing the Epley maneuver incorrectly. The Epley maneuver, the modified Epley, and all the particle repositioning maneuvers for BPPV require very precise, technically accurate performance to be effective. Incorrect Techniqueįirst of all, many providers who are “dabbling” in vertigo care perform the maneuver incorrectly. In this blog, I discuss the top five reasons why the Epley maneuver may not be effective for BPPV treatment. Since then, many healthcare providers and vertigo researchers around the world have developed a whole catalog of additional “ particle repositioning maneuvers.” It is the first procedure of its kind, published in the early 90’s by the late US-based physician named, John Epley. The Epley maneuver is used to reposition BPPV crystals. Many people with dizziness or vertigo have heard of the “ Epley maneuver” as a treatment. The Epley Maneuver for BPPV Particle Repositioning