The canalith repositioning procedure can help relieve benign paroxysmal positional vertigo (BPPV), a condition in which you have brief, but intense, episodes of dizziness that occur when you move your head. Vertigo usually comes from a problem with the part of the inner ear responsible for balance (vestibular labyrinth). BPPV occurs when tiny particles called otoconia in one part of your inner ear break loose and fall into the canals of your inner ear.
The canalith repositioning procedure can move the otoconia to a part of your ear where they won't cause dizziness. Performed in your doctor's office, the canalith repositioning procedure consists of several simple head maneuvers. The procedure is quite effective, relieving vertigo in approximately 80 percent of individuals after one or two treatments. However, the problem may recur.
The canalith repositioning procedure is performed to move the symptom-causing otoconia from the fluid-filled semicircular canals of your inner ear into a tiny bag-like open area (vestibule) that houses one of the otolith organs (utricle) in your ear. Once there, these particles won't cause vertigo and will likely dissolve or be reabsorbed by bodily fluids in your ear.
The canalith repositioning procedure should always be performed under the supervision of a medical professional due to certain risks involved, such as:
- Neck or back injury
- Movement of the otoconia into a canal other than the utricle, which could continue to cause vertigo
- Side effects, including feelings of nausea, dizziness and lightheadedness, which may require medication to relieve
Make sure you tell your doctor about any medical conditions you have, such as a neck or back condition, a detached retina, or vascular problems, before beginning the canalith repositioning procedure. You may need to delay having the canalith repositioning procedure.
There are no special preparations for the canalith repositioning procedure. Wear clothing that will allow you to move freely through each of the maneuvers.
The canalith repositioning procedure involves holding four positions for about 30 to 45 seconds each or as long as symptoms remain while you hold that position. Typically, you will remain in each position an extra 20 seconds after your symptoms have stopped. The procedure may be repeated three or more times within a treatment session.
Depending on your health provider’s preferences, you may wear an infrared imaging device over your eyes. This device helps your health provider examine your eyes during each maneuver. The device can help but it isn't necessary for successful treatment.
Here are the steps involved in the canalith repositioning procedure.
Step 1. First you move from a sitting to a reclining position with your head turned to the affected side by 45 degrees. Your health provider will help extend your head over the edge of the table at a slight angle.
Step 2. With your head still extended over the edge of the table, you'll be prompted to turn your head slowly away from the affected side by about 90 degrees.
Step 3. Roll onto your side. Your head should be slightly angled while you look down at the floor.
Step 4. Finally, you return carefully to a sitting position with your head tilted down and returned to the center position.
After the procedure
After the procedure, you'll need to keep the treated ear above the level of your shoulder for the rest of that day, so don't lie flat the rest of the day of treatment. At night, sleep on a slight incline with your head above your shoulders, using a few pillows. This lets the particles floating in your vestibular labyrinth settle into your utricle or be reabsorbed by your body fluids.
The next morning, following your doctor's instructions, you may need to perform similar exercises — but without hanging your head over the edge of the bed — by yourself to check whether the procedure in the office was effective. If your vertigo continues, tell your doctor. You may need to perform these exercises for several days before your symptoms subside.
Nearly 80 percent of people who undergo the procedure experience relief. If symptoms return, however, then a repeat of the canalith repositioning procedure can be used. It may be necessary to repeat the procedure several times to relieve your symptoms. Talk to your doctor if your symptoms don't improve.
June 30, 2015
- Hilton, MP et al. The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database System Review. 2014;12:CD003162. Review.
- Gold, DR et al. Repositioning maneuvers for benign paroxysmal positional vertigo. Current Treatment Options Neurology. 2014;16(8):307.
- Helminski, JO. Effectiveness of the canalith repositioning procedure in the treatment of benign paroxysmal positional vertigo. Physical Therapy. 2014;94(10):1373. Review.
- Canalith repositioning procedure — for treatment of BPPV. Vestibular Disorders Association. http://vestibular.org/understanding-vestibular-disorders/treatment/canalith-repositioning-procedure-bppv. Accessed April 21, 2015.
- Clinical practice guideline: Benign paroxysmal positional vertigo. American Academy of Otolaryngology — Head and Neck Surgery Foundation. http://www.entnet.org/Practice/loader.cfm?csModule=security%2fgetfile&pageid=33697. Accessed April 21, 2015.