Benign Paroxysmal Positional Vertigo: An Integrated Perspective

Figure 2

Illustration of the Epley maneuver for the treatment of left posterior canal BPPV. From a seated position (top), the patient’s head is turned 45° to the left (2nd from top). The patient is laid down with the head rotated to the left and neck is extended (3rd from top). Next, the head is turned 90° to the right (4th from top) followed by rolling the body to the right such that patient is lying on the right shoulder looking toward the floor (2nd from bottom). Finally, the patient is returned to the seated position with head remaining rotated to the right (bottom). Each position is held for at least 30–60 seconds or until nystagmus or vertigo has resolved. Frenzel lenses can facilitate visualization of nystagmus. Adapted from Mitka [151].