The Epley, Lempert and exaggerated Dix-Hallpike maneuvers are techniques used to reposition displaced inner-ear crystals called otoconia, explains Vestibular Disorders Association. Each maneuver involves moving the head in certain directions to guide the crystals out of the affected inner ear canal.
Three semi-circular canals exist in the inner ear, namely the posterior, horizontal and anterior canals. Choosing the most appropriate maneuver depends in which canal the otoconia are located. If the crystals are located in the posterior canal, the Epley maneuver is the best option, states Vestibular Disorders Association. Since finding otoconia in the horizontal canal is rare, no gold standard of treatment exists. The Lempert, Gufoni and Vannucchi-Asprella liberatory maneuvers are all used to treat the affected horizontal canal, but the Lempert maneuver is the most adequately studied. An exaggerated, or deep, Dix-Hallpike maneuver is the most logically proposed maneuver to treat an affected anterior canal.
Patients can expect residual dizziness for up to three months after a successful treatment, reports Vestibular Disorders Association. Sleeping in an elevated position, positioning the opposite side of the treated ear on the pillow, and wearing a cervical collar are recommendations to prevent a relapse. The cervical collar serves as a reminder to avoid quick head movements.