BPPV assessment and the Epley manoeuvre in Eastbourne
Updated: Nov 3
By Andy Duckmanton, BOst (Hons), GOsC registered osteopath.
Editorial update: 15 October 2026.
This guide explains a BPPV appointment at Eastbourne Osteopathy: preparation, testing, treatment choices and follow-up. For the usual symptom pattern and other causes of dizziness, see BPPV and dizziness: when to seek help.
When routine assessment is not the right route
Vertigo with double vision or loss of vision, hearing loss, speech difficulty, or arm or leg weakness, numbness or tingling needs 999 or A&E. Do not drive yourself. Severe headache, marked nausea or vomiting, or fever with vertigo needs urgent GP or NHS 111 advice.
A previous BPPV diagnosis does not explain every later episode. Sudden, ongoing vertigo with new difficulty walking needs emergency assessment via 999 or A&E. See NHS urgent advice and NICE guidance on dizziness.
Before the appointment
Mention dizziness or BPPV when contacting the clinic so the appropriate appointment can be discussed.
Bring a current medicine list and details of previous dizziness assessment or treatment.
Tell Andy about neck or back difficulties, recent operations, circulation problems, stroke, pregnancy or anything that makes lying back or turning difficult.
Wear comfortable clothing that allows supported changes of position.
Consider bringing someone who can help you travel home. Do not plan to drive immediately after a manoeuvre or while dizzy.
There are three entrance steps and one internal step at the clinic. Please call first if balance or access is a concern. See location and fees.
History, examination and consent
Andy will ask when dizziness occurs, how long it lasts, what triggers it and whether there are hearing, headache, fainting or neurological symptoms. Medical assessment or referral may be the appropriate next step.
The Dix-Hallpike manoeuvre is a diagnostic test; Epley is a treatment. Testing uses supported changes in head and body position while eye movements are observed to help identify the affected ear and canal.
If testing is inconclusive, Andy will explain whether further testing or referral is appropriate.
Testing can briefly bring on spinning or nausea. The procedure and alternatives will be explained; you can ask questions, decline or ask to stop. Positioning may need modification, or testing may be unsuitable.
NICE recommends repositioning by a trained practitioner when BPPV is confirmed. People with unstable cervical spine disease need referral through an appropriate pathway. See NICE NG127, recommendation 1.2.6.
The GOsC consent standards require an explanation of likely benefits, material risks and alternatives, with ongoing consent. You can decide not to proceed or withdraw consent during the appointment.
What the Epley manoeuvre does
Epley uses a sequence of positions to move displaced crystals out of the posterior semicircular canal, a common location for BPPV. Another canal or diagnosis may need a different approach.
Some people improve after one treatment; others need further assessment or treatment. Improvement and the number of appointments cannot be guaranteed. This is a repositioning procedure for a particular inner-ear problem, not a treatment for all dizziness.
Treatment choices and possible unwanted effects
Observation with planned follow-up is an option for some people. Medicines do not reposition the crystals, and the specialist BPPV guideline advises against routine use of vestibular-suppressant medicines for BPPV. Discuss prescribed medicines with your prescriber before changing them.
Testing and treatment may briefly provoke spinning or nausea. Occasionally crystals move into another canal, requiring a different approach. The Royal Berkshire NHS leaflet explains possible complications, including very rare serious events. Suitability and risks need to be discussed in the context of your health and mobility.
Aftercare and returning to activity
Allow time to feel steady before leaving. Temporary nausea or imbalance can occur. Arrange help with travel and avoid driving, ladders or machinery until it is safe to resume them.
The AAO-HNSF BPPV guideline advises against routine restrictions on sleeping position or head movement after repositioning for posterior-canal BPPV. Individual advice may still be needed for another medical reason or fall risk.
Only use home repositioning exercises after a clinician has confirmed the relevant side and pattern, checked suitability and shown you the technique. Do not repeatedly copy an online manoeuvre for unexplained or changing symptoms.
Reviewing the result
Agree a review plan before leaving. The specialist BPPV guideline recommends reassessment within one month, sooner if symptoms persist or make daily activities unsafe.
Persistent symptoms may reflect unresolved BPPV, another affected canal or a different balance disorder. Further assessment may lead to a different manoeuvre, balance rehabilitation or referral rather than simply repeating Epley.
Seek medical review for new or changed symptoms, and follow the urgent advice above. Continuing repeated manoeuvres without reassessment is not the answer when the pattern is unclear.
Andy Duckmanton BOst (Hons) is a GOsC-registered osteopath, qualified since 2007. To discuss a BPPV appointment, call 01323 335052 or use online booking, mentioning BPPV. Read your first appointment for general consent and appointment information.
Sources and further information
Sources checked: 15 October 2026. General patient information; assessment and care depend on your individual circumstances.
Patient information from Eastbourne Osteopathy. About Andy Duckmanton, BOst (Hons), GOsC registered osteopath.