👂 Epley Maneuver Step-by-Step Simulator

Head Turned 45° Toward the Affected Ear

Starting posture aligns the posterior canal with the plane of movement.

• 45°: Head rotation (toward affected ear)
• Seated: Posture (upright on table edge)
• Posterior: Canal aligned (semicircular canal)
• ~1–2s: Duration (brief starting hold)

Why this starting angle

Placeholder: aligns canal plane with the vertical repositioning axis.

Placeholder: correct starting angle is confirmed by Dix-Hallpike testing.

Rapid Recline to Supine With Head Extended

Gravity begins pulling otoconia along the canal toward the common crus.

• 20°: Head extension (below table level)
• Rapid: Transition speed (minimizes symptom lag)
• Peaks here: Nystagmus (torsional, upbeating)
• ≥30s: Hold target (until symptoms settle)

Gravity-driven migration begins

Placeholder: crystals start moving toward the canal exit under gravity.

Placeholder: this position typically provokes the strongest vertigo.

Head Turned 90° to the Opposite Side

Continued rotation moves crystals further along the canal arc.

• 90°: Head rotation (toward unaffected side)
• 135°: Cumulative turn (from initial position)
• Mid-arc: Canal position (approaching common crus)
• ≥30s: Hold target (per position)

Mid-sequence repositioning

Placeholder: otoconia traverse the widest part of the canal loop.

Placeholder: symptoms usually diminish compared to position 2.

Body and Head Rotated Further, Facing Down

Rolling onto the shoulder brings crystals to the canal opening.

• ~135°: Body roll (onto unaffected shoulder)
• Downward: Face orientation (toward floor)
• Reached: Canal exit (near common crus opening)
• ≥30s: Hold target (before sitting up)

Approaching the utricle

Placeholder: crystals near the exit into the utricular cavity.

Placeholder: careful slow movement avoids crystals re-entering canal.

Sit Up — Otoconia Repositioned Into the Utricle

Slow return to upright deposits crystals safely in the utricle.

• Upright: Final posture (seated, chin tucked)
• Utricle: Crystal location (no longer canal-active)
• ~80%: Success rate (single-session placeholder)
• Recommended: Follow-up (repeat if symptoms persist)

Completion of the maneuver

Placeholder: repositioning complete; monitor for residual symptoms.

Placeholder: a Brandt-Daroff exercise may reinforce results.