Epley Manoeuvre: number of times it is required and its diagnostic value
Reviewed by Madhup K Chaurasia

Benign paroxysmal positional vertigo is a common condition but if inadequately treated or wrongly diagnosed, can prolong the distressing symptoms of momentary dizziness, nausea and visual disturbances which can be due to other causes and deteriorate quality of life. Studies on the subject of BPPV hitherto have not addressed the number of times the Epley manoeuvre is required to get rid of BPPV. In this article, the authors present a review of treatment of 70 patients diagnosed with BPPV and offered the Epley manoeuvre in the first appointment and then repeatedly in four weekly follow-up appointments until they were asymptomatic and had negative Dix-Hallpike tests. Forty-seven percent of these patients were asymptomatic after one treatment and 84% required three of fewer treatments to become asymptomatic. The authors emphasise the diagnostic role of the Epley manoeuvre, in that if the condition is not cured after three treatments, the diagnosis of BPPV should be questioned and further investigations carried out. The possibility of migraine should be considered. The study highlights the effective role of this simple and non-invasive management technique, which if used repeatedly if required, can not only cure the disease but also help in choosing other avenues for a diagnosis.

How many Epley manoeuvres are required to treat benign paroxysmal positional vertigo?
Hughes D, Shakir A, Goggins S, Snow D.
THE JOURNAL OF LARYNGOLOGY AND OTOLOGY
2015;129:421-4.