Nystagmus during and after the Epley maneuver

While extensive research exists on the efficacy of the Epley maneuver, studies examining nystagmus findings during treatment are limited. This study aimed to examine posterior canal benign paroxysmal positional vertigo (BPPV) to determine whether nystagmus findings during the Epley maneuver can predict efficacy. Additionally, we investigated the occurrence of nystagmus in the sitting position immediately following treatment. The participants comprised 50 consecutive cases of posterior canal BPPV. Eye movements during and after the Epley maneuver were observed. Patients were asked to revisit within a week for the Dix-Hallpike test. A high incidence of torsional nystagmus towards the affected side was observed in the healthy-ear-down 135° position, occurring in 62% of cases. This finding indicates that the treatment was successful. However, not all cases exhibiting this nystagmus achieved complete recovery. Ninety-four % of patients did not exhibit nystagmus in the final position, even though pathological debris was stimulating the utricle. Nystagmus findings during the Epley maneuver cannot always predict the efficacy. The occurrence of nystagmus in the final position is very low, suggesting that stimulating the utricle may not always induce nystagmus.