Benign Positional Vertigo

Put the crystals back where they belong, please.


The Epley Maneuver: The Vestibular Labyrinth Maze Challenge 


Background: 

There is a tiny organ in our ears called the “vestibular labyrinth.” This labyrinth contains three structures that sense our position in space. The loop-shaped structures (semicircular canals) monitor our head’s rotation while the other two structures (the otolith organs) contain tiny crystals that help us sense our head’s position relative to gravity.


When the tiny crystals of the otolith organs become dislodged, by for example whiplash, they can roll into the semicircular canals. The presence of these crystals in the semicircular canals makes us sensitive to the slightest changes in head rotation that we normally would not be sensitive to, giving us the sensation of the room spinning, or vertigo. This causes a condition called “benign paroxysmal positional vertigo” but for anyone who’s ever experienced this misery, it feels anything but benign. 


Since these misplaced crystals trigger such torment, the objective of The Vestibular Labyrinth Maze Challenge (or what is known as The Epley Maneuver), is to prod the crystals back to its proper position by a series of repositioning maneuvers, kind of like moving the marble in the Labyrinth Wooden Maze game.


Who can Play?

People diagnosed with benign positional vertical, who are aware of the side of affected ear, and are medically cleared by their provider for the Epley Maneuver.


How to Play

Follow these steps if the problem is with your right ear:

  • Start by sitting on a bed.

  • Turn your head 45 degrees to the right.

  • Quickly lie back, keeping your head turned. Your shoulders should now be on the pillow, and your head should be reclined. Wait 30 seconds.

  • Turn your head 90 degrees to the left, without raising it. Your head will now be looking 45 degrees to the left. Wait another 30 seconds.

  • Turn your head and body another 90 degrees to the left, into the bed. Wait another 30 seconds.

  • Sit up on the left side.

Follow these steps if the problem is with your left ear:

  • Start by sitting on a bed.

  • Turn your head 45 degrees to the left.

  • Quickly lie back, keeping your head turned. Your shoulders should now be on the pillow, and your head should be reclined. Wait 30 seconds.

  • Turn your head 90 degrees to the right, without raising it. Your head will now be looking 45 degrees to the right. Wait another 30 seconds.

  • Turn your head and body another 90 degrees to the right, into the bed. Wait another 30 seconds.

  • Sit up on the right side.

How does it compare to the classic Labyrinth Wooden Maze game?

The objective of the Labyrinth Wooden Maze game is to try to tilt the playfield to guide the marble to the end of the maze. With the Epley Maneuver, the vestibular labyrinth is our playfield and the goal is to tilt the playfield to guide the crystals back into the otoliths. Unlike the Labyrinth Wooden Maze game, there are no holes in the playfield. There is simply a set course and therefore, a strategic set of maneuvers to navigate the crystals to its appropriate home.  When performed properly, there is high likelihood of relief from vertigo: A large study of nearly a thousand patients found that a single maneuver was effective in 85 percent of patients, with only 2 percent requiring more than three treatments.