Are repositioning procedures effective in benign paroxysmal positional vertigo (BPPV)?

Photo of a woman with vertigo standing up (PantherMedia / Tatiana Gladskikh) The Epley maneuver and the Semont maneuver are simple treatments that can get rid of benign paroxysmal positional vertigo. They are considered if the vertigo is being caused by tiny crystals (deposits) in the ear’s organ of balance.

About 2 out of 100 people are affected by benign paroxysmal positional vertigo (BPPV) at some point in their lives. It causes sudden episodes of dizziness when you stand up, or turn or tilt your head. Even turning over in bed can make you feel dizzy. The dizziness can also cause nausea.

BPPV is often caused by tiny crystals (deposits) in the posterior semicircular canal – a part of the ear’s organ of balance (vestibular system). In that case both the Epley maneuver and the Semont maneuver can make the symptoms go away. The treatments involve following a sequence of movements to turn your head and reposition your torso. They aim to help move the bothersome crystals out of the semicircular canals and into a less sensitive part of the ear. These movements are performed with the help of a doctor.

Research on effectiveness

Researchers from the Cochrane Collaboration – an international network of researchers – analyzed eleven studies on the Epley maneuver. Nearly 750 adults who had BPPV took part in these studies.

The results show that the Epley maneuver is very likely to get rid of this type of vertigo: After up to four weeks, a comparison of the two groups showed the following:

  • The BPPV symptoms had gone away in 20 out of 100 people who didn’t use the maneuver,
  • compared to 52 out of 100 people who did use the Epley maneuver.

This means that the Epley maneuver prevented further episodes of vertigo in an additional 32 out of 100 people.

Studies comparing the Epley manuever with the Semont maneuver found that the two are equally effective.

Possible side effects

Because the repositioning procedures didn’t cause any serious complications in the studies, researchers assume that they are safe. But the maneuvers themselves can sometimes cause episodes of vertigo.

Even if the Epley maneuver is successful, BPPV might return again. But the treatment can be repeated if that happens. It doesn’t take long and can be performed by a family doctor, for instance.