Although most people with BPPV can be treated with the Epley maneuver or a home treatment device. About 5-12% of people cannot be treated. There are several reasons which should be carefully considered.
1) You do not have BPPV. There are many kinds of vertigo and only BPPV will respond to the Epley maneuver. You should always get a proper diagnosis from a physician qualified to diagnose BPPV. Several serious conditions can cause vertigo as part of their symptom complex and these other conditions should be ruled out.
2) You have BPPV but are doing the maneuver incorrectly. This is actually the most common reason for treatment failure in people with BPPV. This may be because you are treating the wrong side or may be because you are performing the maneuver too quickly, with the wrong angles or in the wrong order. The maneuver is only effective when performed totally correctly. A BPPV treatment device to assist in the correct performance of the maneuver is available and will visually guide a person through the maneuver.
3) You may have a resistant form of BPPV. This may be due to the fact that the otoconia, or ear crystals, get stuck in the balance canal or that they get glued to the end of the canal. It is not clear which is true but it seems that some people don’t respond whatever they do.
4) You may have BPPV in both ears. Due to the nature of BPPV if you have it in one ear it is certainly possible to get it in both ears. Typically this will present with symptoms on both sides. A physician can tell you if this is the case. The Epley maneuver will still work but you will have to do it on both sides. People often ask if doing one side and then the other will reverse the benefit of the first maneuver. It is not clear that this is true however, we always tell people to treat one side one week then the other side the next week.
With these issues in mind it doesn’t hurt to perform an Epley maneuver in a repeated fashion, it might help but this cannot be guaranteed. The only caution is that if you have symptoms which do not seem related to BPPV such as weakness or confusion you should seek medical attention.