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Figure 1. (A) Instructions for the modified Epley procedure (MEP) for left ear posterior canal benign paroxysmal positional vertigo (PC-BPPV). For right ear BPPV, the procedure has to be performed in the opposite direction, starting with the head turned to the right side. 1. Start by sitting on a bed with your head turned 45° to the left. Place a pillow behind you so that on lying back it will be under your shoulders. 2. Lie back quickly with shoulders on the pillow, neck extended, and head resting on the bed. In this position, the affected (left) ear is underneath. Wait for 30 secondS. 3. Turn your head 90° to the right (without raising it), and wait again for 30 seconds. 4. Turn your body and head another 90° to the right, and wait for another 30 seconds. 5. Sit up on the right side. This maneuver should be performed three times a day. Repeat this daily until you are free from positional vertigo for 24 hours. (B) Instructions for the modified Semont maneuver (MSM) for left ear PC-BPPV. For right ear BPPV, the maneuver has to be performed in the opposite direction, starting with the head turned toward the left ear. 1. Sit upright on a bed with your head turned 45° toward the right ear. 2. Drop quickly to the left side, so that your head touches the bed behind your left ear. Wait 30 seconds. 3. Move head and trunk in a swift movement toward the other side without stopping in the upright position, so that your head comes to rest on the right side of your forehead. Wait again for 30 seconds. 4. Sit up again. This maneuver should be performed three times a day. Repeat this daily until you are free from positional vertigo for 24 hours. (See the video in the supplementary material on the NeurologyWeb site; go to www.neurology.org.)
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