Epley Observations of nystagmus during the Epley maneuver Kohichiro Shigeno Shigeno Otolaryngology Vertigo-Hearing Impairment Clinic A single Epley maneuver was performed for 145 patients with unilateral posterior canal-benign paroxysmal positional vertigo (BPPV) caused by canalolithiasis, and the efficacy of repositioning was evaluated using the Dix-Hallpike test on the following day. The nystagmus pattern observed during the Epley maneuver and the results of repositioning were analyzed. Of the 145 patients, 114 (79%) exhibited a resolution of BPPV, whereas 19 (13%) exhibited typical posterior canal-bppv caused by canalolithiasis, 7 (5%) exhibited a variant of posterior canal-bppv inducing a positional downbeat nystagmus, and the remaining 5 (3%) exhibited conversion to other forms of BPPV such as lateral canal-bppv. During the Epley maneuver, upbeat-rotatory toward the affected ear nystagmus, downbeat rotatory toward the healthy ear nystagmus, downbeat-rotatory toward the affected ear nystagmus, and no nystagmus were observed. However, the nystagmus pattern during the Epley maneuver was not correlated with the results of repositioning. An upbeat-rotatory toward the affected ear nystagmus indicates the movement of free debris toward the nonampullated end of the posterior canal. A downbeat-rotatory toward the healthy ear nystagmus might imply a secondary phase of nystagmus elicited in the previous head position or the co-existence of a posterior canal-bppv caused by canalolithiasis of the short-arm. A downbeat-rotatory toward the affected ear nystagmus indicates free debris moving toward the non-ampullated end of the anterior canal to the common crus. No nystagmus indicates that the debris did not move during the head positioning, possibly suggesting that free debris moving through the common crus did not result in the development of nystagmus. Key words: Epley maneuver, nystagmus, anterior canal, common crus Benign Paroxysmal Positional Vertigo BPPV BPPV Canalith repositioning procedure Epley Particle repositioning maneuver Parnes Semont ( 165 )
BPPV BPPV BPPV BPPV BPPV BPPV BPPV BPPV Ewald Canalith jam BPPV Epley Dix-Hallpike Epley BPPV Epley BPPV Dix-Hallpike ( 166 )
BPPV Epley Epley Epley Dix-Hallpike Head roll test Dix-Hallpike BPPV BPPVshort-arm BPPV BPPV-short-arm Short-arm Epley Vibrator Epley Epley CCD SN IR 1 ImageJ VOG Epley ( 167 )
Epley BPPV Dix-Hallpike Epley Epley Dix- Hallpike Epley Head roll test Epley Dix-Hallpike Epley Dix-Hallpike Re-entry Epley Dix-Hallpike Epley Epley Epley BPPV Epley BPPV Dix-Hallpike BPPV ( 168 )
BPPV Dix-Hallpike Epley BPPV BPPV BPPV BPPV Canalith jam Vannucchi Dix-Hallpike Epley Epley Epley Mann- Whitney p 0.05 Epley Dix- Hallpike Epley Epley BPPV Epley BPPV BPPV ( 169 )
Epley Nose-down BPPV BPPV BPPV BPPV-short-arm Epley ( 170 )
Epley Epley P-BPPV P-BPPV Epley Epley Epley BPPV BPPV p 0.47 p 0.56 p 0.58 Epley Epley Head roll test BPPV BPPV BPPV BPPV ( 171 )
BPPV Parnes particle repositioning maneuver Furman heels over head rotation Vibrator Oh Epley BPPV Heels over head rotation Parnes Heels over head rotation Oh Epley Epley BPPV Baloh Dix-Hallpike BPPV BPPV ( 172 )
Epley Epley Epley Epley BPPV Epley Epley Baloh BPPV Furman Dix-Hallpike BPPV Furman BPPV Baloh BPPV Epley Epley BPPV-short-arm Herdman Epley ( 173 )
BPPV-short-arm Oh Epley Epley Herdman Epley long-arm Nose-down Dix-Hallpike Long-arm Long-arm long-arm Epley Nose-down Epley Epley Epley Epley Epley Longarm ( 174 )
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