Sit the patient on an examination couch and turn the head 45 degrees to one side. Keeping the head turned, lie the patients down, lowering the head below the level of the couch.
Leave the patient in this position for 10 to 20 seconds to see if they exhibit any nystagmus. Then bring them upright before turning the head to the opposite side and repeating the procedure to confirm which is the affected ear.
Leave the patient in this position for 10 to 20 seconds to see if they exhibit any nystagmus. Then bring them upright before turning the head to the opposite side and repeating the procedure to confirm which is the affected ear.
For the Epley manoeuvre, repeat steps 1 and 2 with the affected ear (in this case the left) undermost - but do not bring the patient upright again. Wait until the nystagmus settles and a further 20 to 30 seconds. Then turn the head to the right 90 degrees and wait 30 seconds. There may be further nystagmus.
The patient should then be helped (a nurse is handy) to roll on to their right side so that they can turn their head to look down to the floor and tuck their chin into their chest. Again, wait a further 30 seconds 
Help the patient sit up on the edge of the bed with their legs over the side. Ensure they look down as they sit up. After 20 seconds, some patients exhibit patterns or nystagmus and feel nauseous or even vomit. After a minute, perform a further Hallpike test.
