Which condition is most appropriately treated with the Epley maneuver?

• A. Posterior canal BPPV
• B. Menière disease
• C. Vestibular neuritis
• D. Vestibular schwannoma

Answer: (A)

The main idea is that the Epley maneuver is a canalith repositioning technique designed to move free-floating otoconia out of the posterior semicircular canal and into the utricle, where they won’t provoke vertigo with head changes. This makes it especially effective for posterior canal BPPV, the form of BPPV most commonly caused by debris in that canal. By guiding the crystals through the canal with specific head and body positions, gravity helps restore normal endolymph flow and stop the provocative nystagmus and spinning sensations.

This is why it’s the best choice here: other conditions involve different mechanisms and would not be addressed by a canalith repositioning maneuver. Menière disease stems from fluctuating inner ear fluid pressure (endolymphatic hydrops) and presents with episodic vertigo often accompanied by hearing loss and tinnitus, which a repositioning maneuver doesn’t treat. Vestibular neuritis is an inflammatory disruption of the vestibular nerve, leading to acute vertigo without a positional component that requires crystals to be moved. Vestibular schwannoma is a tumor affecting the vestibular nerve, requiring imaging and medical or surgical management rather than maneuvers to reposition otoconia.