normally only with head movement doesfluid within the inner ear also move informing the brain that a head turn occurred however should a crystal called an otoliththat gets displace into the poster canal of the inner ear,bppv dizziness occurs. fluid movement occursdue to the crystal rather than head turns causing the brain to think movement has occurred even though none has happened. when the epley maneuver is performed totreat this posterior canal bppv by trying to get the loose crystalout of the canal
this maneuver is started by turning thehead forty-five degrees and the body laid back such the head is extendedabout 20 to 30 degrees. if bppv is present, eye twitching call nystagmus will occur. after 30 to 60 seconds the head is turned 90 degrees to theopposite side and held for another 30 to 60 seconds the head is then further rotated another90 degrees accomplished by having the patient turnonto their side which is then held for another 30 to 60 seconds. at thispoint the head should be turned 45
degrees from the horizontal. when performing this maneuver anotherindividual can help with these position changes the maneuvers then completed by havingthe patient sit up. so what's going on with these positionchanges? essentially the head has moved in such a way to manipulate the crystalto fall towards the canal opening. with each position change it takes about 30 to 60 seconds for the crystal to settle into the mostdependent position in the canal. if turns are made before the crystal hasa chance to settle
the crystal may fall back the wrong wayand the maneuver will fail. it is also important that they headpositions are angled correctly or else the crystal will not settle to thecorrect position in the canal and the maneuver will fail. also if the position changes are donetoo slowly the crystal may not settle quickly enough from lack of momentum and the maneuver will also fail. once thecrystal falls out of the canal, the dizziness shouldresolve if due to posterior canal bppv.
