Which maneuver is first-line treatment for benign paroxysmal positional vertigo (BPPV)?

The Epley maneuver is considered the first-line treatment for benign paroxysmal positional vertigo (BPPV), specifically for the most common type affecting the posterior semicircular canal. This technique involves a series of specific head and body movements designed to reposition displaced otoliths (calcium carbonate crystals) that cause vertigo when they interfere with normal fluid motion in the inner ear during head movements.

When performed correctly, the Epley maneuver helps to move the otoliths from the affected canals back into the utricle, where they no longer provoke vertiginous symptoms. The effectiveness of the Epley maneuver in alleviating vertigo symptoms in patients with BPPV is well-supported by clinical evidence, making it the preferred approach for immediate relief.

Other treatments, such as Brandt-Daroff exercises, the Semont maneuver, and general canalith repositioning procedures, can also be employed, but they may not be as effective or are often used in specific circumstances or cases where the Epley maneuver is not suitable. Thus, the Epley maneuver is widely recognized and practiced as the best initial option for managing BPPV.