How to perform the Epley Maneuver

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Rotate the patient’s head 90 degrees toward the unaffected side.

Guide the patient to the side lying position with their nose pointing to the ground.

While keeping the head in 45º, tucked position, return the patient to a seated position.

It is most helpful to utilize Frenzel lenses or VNG while performing CRP. This reduces the ability of the patient to fixate during the procedure in an attempt to reduce the nystagmus response. This will also allow the examiner to see even very slight torsional nystagmus.

Before performing any positioning maneuver, it is important to ascertain whether the patient has current or past injuries of the neck or spine.

If neurological symptoms occur during the execution of positioning maneuvers, discontinue the procedure immediately and refer for a neurological evaluation. These symptoms might include, blurred vision, numbness, weakness of the arms or legs or confusion.

Efficacy of the procedure is increased to more than 90% if CRP is performed twice in rapid succession.

It is not unusual for the patient to lose postural control at the completion of the procedure due to the otoconia briskly falling within the cupula. It is vital that the examiner is in a stance that will provide postural support to the patient.