This maneuver was created by Dr. John Epley in 1980. The patient sits upright, legs outstretched, in front of the physician. The head is turned 45° to the affected side, so the physician is looking at the good ear. Then the patient changes rapidly to a supine position so that the head hangs over the edge of the examination table. The patient must remain in this position until the vertigo and nystagmus have receded (at least 1 minute). Then the patient turns onto the healthy side, keeping his head in the same position, and waits approximately another minute. The last step in this maneuver is sitting upright again. The patient should keep his eyes closed to avoid any vertigo-induced nausea during this maneuver.
If the patient does not respond to this treatment, positional training, according to Brandt and Daroff, is recommended. During these exercises, the patient changes position alternately to the right and the left. He remains in one position for about 30 seconds, and he sits upright again in between the positions.