BPPV: repositioning manoeuvres

Epley canalith repositioning manoeuvre (CRM)

• The subject is sitting upright with the head turned 45° towards the affected ear
• The subject is then rapidly laid supine with the head hanging down 20° for 20-30 seconds
• The head is then turned 90° towards the unaffected side for 20 seconds.
• The head is then turned a further 90° for 20-30 seconds.
• The subject is then put back upright

References

1. Bhattacharyya N, Gubbels SP, Schwartz SR, et al. Clinical practice guideline: benign paroxysmal positional vertigo (update). Otolaryngol Head Neck Surg 2017; 156(3_suppl):S1-S47.
2. Nguyen-Huynh AT. Evidence-based practice: management of vertigo. Otolaryngol Clin North Am 2012; 45:925-940.
3. Seemungal BM, Bronstein AM. A practical approach to acute vertigo. Pract Neurol 2008; 8:211-221.
4. Bhattacharyya N, Baugh RF, Orvidas L, et al. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 2008; 139:S47-S81.
5. De la Meilleure G, Dehaene I, Depondt M, Damman W, Crevits L, Vanhooren G. Benign paroxysmal positional vertigo of the horizontal canal. JNNP 1996; 60:68-71.
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Related checklists

• Posterior canal BPPV
• Horizontal canal BPPV
• Anterior canal BPPV
• Subjective (type 2) BPPV
• BPPV: differential diagnosis
• BPPV: management