Outline the Epley maneuver and its intended therapeutic effect for BPPV.

• A. A canalith repositioning maneuver that moves free otoconia through the semicircular canal into the utricle to alleviate symptoms.
• B. A procedure to surgically remove otoconia from the canal.
• C. A pharmacologic regimen to dissolve otoliths.
• D. A physical therapy to strengthen neck muscles.

Answer: (A)

The Epley maneuver is a canalith repositioning technique that uses gravity to move displaced otoconia from the posterior semicircular canal back into the utricle, where they no longer trigger vertigo. When these crystals float into the canal, everyday head movements cause abnormal endolymph flow and stimulation of the canal, producing the spinning sensation of BPPV. The maneuver guides the crystals through a series of carefully timed head and body positions, so the crystals travel along the canal toward the utricle and become reabsorbed or settle there harmlessly.

A typical sequence starts with the person seated, head turned about 45 degrees toward the affected ear. They are then brought to a supine position with the head hanging slightly off the table to align the posterior canal with gravity. After holding briefly, the head is rotated 90 degrees to the opposite side, the patient rolls onto that side while keeping the head rotated, and finally they are brought to a sitting position. Repeating the maneuver can help if symptoms recur.

This approach specifically targets repositioning otoconia, unlike surgical removal, pharmacologic dissolution, or general neck strengthening, which do not address the underlying mechanism of canaliths in the semicircular canal.