How Do You Do the Canalith Repositioning Maneuvers?

The canalith repositioning procedure can help relieve benign paroxysmal positional vertigo

The canalith repositioning procedure can help relieve benign paroxysmal positional vertigo (BPPV). BPPV is a condition in which a patient has brief, yet intense, episodes of dizziness and vertigo that occur when they move their head. Vertigo usually occurs when there is a problem with the part of the inner ear that is responsible for the balance. BPPV occurs when tiny canalith particles in one part of the inner ear break loose and fall into the semicircular canals of the inner ear. The canalith repositioning procedure can move these particles to a part of your ear where they won't cause dizziness. The procedure involves several simple head maneuvers.

The canalith repositioning procedure involves holding four positions for about 30 seconds each or as long as you have symptoms while you hold that position. You may generally stay in each position an extra 30 seconds after your symptoms have stopped. The doctor may watch the eyes for abnormal movements during the procedure. The procedure may be repeated three or more times within a treatment session. Only one ear is treated at a time, which will be identified by your physician or therapist. To perform the maneuver, the health care provider will

• Begin with the patient sitting lengthwise on the examination table.
• Place the Frenzel/Videonystagmography (VNG) goggles on the patient.
• Have the patient turn their head to a 45° angle toward the affected side (the side that needs treatment).
• Maintain the 45° head position and guide the patient in a continuous motion from sitting to lying with the head hanging off the table at approximately 20°. Neck support may be provided during the procedure.
• Ask the patient to hold this position for 30-60 seconds.
• Ask the patient to maintain the 20° head extension and rotate their head 90° toward the unaffected side so that their head is approximately 45° toward the unaffected side.
• Ask the patient to hold this position for 30-60 seconds.
• Still maintain the 45° head position and guide the patient into a side-lying position on the shoulder of the unaffected side. The patient’s nose should be pointed toward the floor.
• Ask the patient to hold this position for 30-60 seconds.
• Instruct the patient to tuck their chin and maintain the 45° head position.
• Guide the patient back into a sitting position and ensure that the patient’s head remains at the 45° angle, and the chin remains tucked. The patient may need to sit still for about 20 minutes.

The specific movements will depend on the location of the canalith particles in your ear. The doctor may likely teach you how to perform the procedure yourself so that you may do it at home if needed.

The canalith repositioning procedure has certain risks such as:

• Neck or back injury
• Movement of the particles to an unintended location, which could continue to cause vertigo
• Side effects, including feelings of nausea, dizziness, and lightheadedness

Recovery process: For several days following the maneuver, please refrain from quick head movements. After the treatment, you will be required to keep your head above the shoulder level, even when sleeping. Your doctor will give you specialized instructions about what symptoms to monitor and how to check to see if the procedure worked. You may be given additional exercises to do at home:

• Keep the head upright and vertical as much as possible for 48 hours after the treatment:
  • You may recline with the head propped up to vertical.
  • You may rotate the head.
  • Please try not to tip the head down, back, or to the side. You can rotate the head (but do not shake it).
• After the first 48 hours, you may lie down, tip the head, and sleep normally for the next 4 days, but
  • Stay off your left/right side when lying down.
  • Do not tip the head back and to the left/right side.

On the sixth day after the treatment, resume all normal activities. Try to provoke your dizziness before seeing your doctor again.

Effectiveness: The canalith repositioning procedure is the most effective and a less time-consuming procedure in treating patients with benign paroxysmal positional vertigo (BPPV), and it is found to have less reoccurrence. Nearly 80% of people who undergo this procedure experience relief. However, if your symptoms return, your doctor can repeat the procedure. The procedure may need to be repeated several times to relieve your symptoms.