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Question

Benign paroxysmal positional vertigo (BPPV) can be quite a debilitating condition for patient it effects.  What are the two maneuvers that are used at the bedside for this condition and how do they differ?

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Answer

The two maneuvers used clinically in the evaluation and treatment of BPPV are:

• Dix-Hallpike Maneuver (diagnosis)
  
  • This is used to diagnosis BPPV and is performed by having the patient starting sitting upright.  The head is then turned to one side and the patient is rapidly lowered to the supine position with their extended over the examination table.  The provider then watches for nystagmus or vertigo symptoms.  If this side is negative, then the maneuver is repeated on the other side.

• Epley Maneuver (treatment)
  • This is used to treat active vertigo in BPPV by attempting to relocate the canalith back into the utricle by using a series of repositioning techniques.
    

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References

• Shim DB, Ko KM, Kim JH, Lee WS, Song MH. Can the affected semicircular canal be predicted by the initial provoking position in benign paroxysmal positional vertigo? The Laryngoscope. 2013; 123(9):2259-63. [pubmed]
• Furman JM, Cass SP. Benign paroxysmal positional vertigo. The New England journal of medicine. 1999; 341(21):1590-6. [pubmed]
• Woodworth BA, Gillespie MB, Lambert PR. The canalith repositioning procedure for benign positional vertigo: a meta-analysis. The Laryngoscope. 2004; 114(7):1143-6. [pubmed]
• White J, Savvides P, Cherian N, Oas J. Canalith repositioning for benign paroxysmal positional vertigo. Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. 2005; 26(4):704-10. [pubmed]