I am 30 years old and have had positional vertigo for almost 20 years. I went to a specialist about 10 years ago but have never received treatment, only tests that made me sick. I used to be on Antivert, but that didn't help. I would like to know more about the Epley maneuver and how it works and if it is effective on someone like me who has had this problem for years.

T.

I've written about benign paroxysmal positional vertigo (BPPV) before. If you haven't already, you should be sure to read that article, since it describes the key features of BPPV and also explains how the Epley maneuver works. I did not describe the Epley maneuver in detail because I despise the idea of people self-diagnosing and self-treating based on information they find on the Web. People who commit this sort of stupidity eventually end up as an item on the Darwin Awards website.

Of course, you aren't going to do anything of the kind, are you? You are only going to share the following information with your ear, nose and throat doctor, aren't you? (Okay, let's be even more blunt: KIDS, DON'T TRY THIS AT HOME.)

The Epley maneuver (and a similar method known as the Semont maneuver) are canalith repositioning maneuvers. In other words, the patient assumes a series of postures designed to move the misplaced canaliths (also known as otoliths, which means "ear stones") into a region of the inner ear where they are less inclined to provoke symptoms.

In the Epley maneuver, the patient begins in a seated position and is then placed supine (lying on his back), with his head hanging a bit off the end of the bed; the head is tilted 45 degrees toward the affected ear. (By the way, figuring out which ear is the affected ear is just ONE reason you need your doctor's input on this one!) The head is then rotated 90 degrees toward the unaffected ear. Keeping the head in this position, the patient is then brought back to a seated posture. Finally, the patient is instructed to tuck his chin in toward his chest. Each position is held until the vertigo (and abnormal eye movement, known as nystagmus) ceases.

In the Semont maneuver, the patient is moved rapidly from a seated position into a side-lying position; this time, the head is turned 45 degrees away from the affected ear. After a few moments, the patient is moved quickly to the original seated posture and then into an opposite side-lying posture.

There is, by the way, a different form of BPPV that responds best to a "barrel-roll maneuver," in which the supine patient executes a 360-degree barrel roll, in 90-degree increments, in the direction of the unaffected ear.

Depending upon your level of cynicism, the choice of maneuver is either (a) dependent upon the doctor's clinical judgment regarding your type of BPPV, or (b) irrelevant. It is certainly true that the Epley and Semont maneuvers appear to be equally effective. Would such techniques be helpful to you? Unfortunately, that greatly depends on whether you have been correctly diagnosed. If you truly have BPPV, then there is an excellent chance that a canalith repositioning technique would help you.

Your doctor may want references for these two techniques. Here they are:

Epley, J.M. The canalith repositioning procedure for treatment of benign paroxysmal positional vertigo. Otolaryngology -- Head and Neck Surgery, Vol. 107, 399-404, 1992.

Semont, A., Freyss, G., and Vitte, E. Curing the BPPV with a liberatory maneuver. Advances in Otorhinolaryngology, Vol. 42, 290-293, 1988.