A series of four head and body positions used to move displaced calcium crystals out of the posterior semicircular canal and back into the utricle. The first-line treatment for posterior canal BPPV.
Medical definition
Described by Dr. John Epley in 1992, the Epley canalith repositioning procedure uses gravity and sequential head movements to guide otoconia (loose calcium carbonate crystals) through the posterior semicircular canal, around the common crus, and back into the utricle where they no longer trigger vertigo. The procedure consists of four positions held for 30 seconds each: the affected-ear Dix-Hallpike position, head rotation to the opposite side, full body roll onto the shoulder, and sitting up. A single successful session resolves symptoms in roughly 80% of patients with posterior canal BPPV.
Why it matters for vertigo
Before the Epley maneuver, posterior canal BPPV was treated with weeks of vestibular exercises or long courses of anti-vertigo medication — neither of which actually removes the crystals from the canal. The maneuver was a shift in how this condition is treated: mechanical repositioning rather than suppression. It works for posterior canal BPPV only. Horizontal canal BPPV needs the BBQ roll or Gufoni maneuver. Anterior canal BPPV requires a different approach — in my clinic, the Bangalore Maneuver, which I developed specifically for that variant.
Where I see this in clinic
I perform canalith repositioning several times a week. The key step that most patients do not get elsewhere is confirming the canal and side before choosing the maneuver. The Epley maneuver applied to horizontal or anterior canal BPPV does not help and can sometimes worsen symptoms. When a patient comes to me after months of failed repositioning attempts, the first question I ask is: did anyone confirm which canal is affected with a Dix-Hallpike before starting treatment? Often the answer is no.
Related terms
Canalithiasis — the mechanism the Epley maneuver treats. Otoconia — the crystals being repositioned. Dix-Hallpike test — the diagnostic test used to confirm the maneuver is indicated. Semicircular canals — the anatomy the maneuver moves crystals through.
Medical Disclaimer: This glossary entry is for educational purposes only. Canalith repositioning maneuvers should be performed or supervised by a clinician after confirming the diagnosis. Home attempts without a confirmed diagnosis can worsen BPPV. Consult Dr. Prateek Porwal directly. WhatsApp: 7393062200.