Canalith repositioning procedure

Overview 

The canalith repositioning procedure (CRP) effectively treats benign paroxysmal positional vertigo (BPPV), a condition causing brief, intense dizziness and spinning when you move your head. BPPV occurs when tiny particles in the inner ear, called otoconia, break loose and move into the semicircular canals, disrupting balance and causing vertigo.

CRP involves a series of simple head movements performed in a healthcare provider’s office, moving these particles to a part of the ear where they won’t cause dizziness. It is effective in about 80% of cases after one or two treatments, though the issue may recur. The Epley maneuver is the most well-known CRP, specifically designed to alleviate BPPV symptoms. 

BPPV is the most common cause of vertigo, triggered by calcium carbonate crystals, or canaliths, detaching from the inner ear and moving into the semicircular canals. The Epley maneuver aims to move these crystals out of the semicircular canals, reducing BPPV symptoms but not addressing other types of vertigo. 

Reasons for undergoing the procedure  

The canalith repositioning procedure, also known as the Epley maneuver, is performed to alleviate symptoms of Benign Paroxysmal Positional Vertigo (BPPV). This procedure moves the particles causing vertigo from the semicircular canals of the inner ear to the utricle, a part of the ear where they won’t cause symptoms. These particles are likely to dissolve or be reabsorbed by the body over time. While you can perform the Epley maneuver at any time, many prefer to do it before bedtime to sleep through any lingering vertigo symptoms. It’s important to consult a healthcare provider before starting any new therapy.

Risk  

The canalith repositioning procedure, while generally safe, carries certain risks. These include neck or back injury, movement of particles causing continued vertigo, and side effects such as nausea, dizziness, and lightheadedness. It’s crucial to inform your healthcare provider of any pre-existing medical conditions, like neck or back issues or advanced rheumatoid arthritis, as these may require delaying the procedure. Additionally, conditions such as retinal detachment or vascular disease should be discussed with your provider. 

Following the Epley maneuver, some individuals may experience nausea, intense vertigo, or vomiting. If not performed correctly, the maneuver can lead to complications, including neck injuries and increased vertigo symptoms. To minimize these risks, ensure your healthcare provider demonstrates the proper technique before attempting it at home.

Before the procedure 

No special preparations are needed for the canalith repositioning procedure. Simply wear clothing that allows you to move freely through each position.

During the procedure  

The canalith repositioning procedure takes approximately five to 10 minutes to finish. The procedure may be repeated three or more times in one session. It is crucial to keep the head down and avoid lifting it during any part of the procedure. The healthcare provider will also observe the eyes for any unusual movements.

During the canalith repositioning procedure, one will hold four positions for around 30 seconds each, or until the symptoms subside. After the symptoms have stopped, one must remain in each position for about 30 more seconds.

The procedure is performed as follows: 

• Transition from sitting to reclining with the head turned 45 degrees to the affected side  
• Gradually move the head to the opposite side by about 90 degrees  
• Lie on the side with the head tilted slightly down, facing the floor. Keep the body aligned with the head when turning.  
• Return to a seated position with the head centered and tilted down. Remain seated quietly for around 15 minutes.  

After the procedure 

After the procedure, follow your health care provider’s instructions, which may include learning to do the procedure at home if needed. You might need to perform these exercises for several days before your symptoms subside. Although there are no specific post-treatment instructions, it’s advisable to avoid sudden head movements and refrain from bending over for the rest of the day.

Outcome 

Nearly 80% of people who undergo the canalith repositioning procedure experience relief from their symptoms. If symptoms return, the procedure can be repeated multiple times as needed to help alleviate them. Many healthcare providers recommend the Epley maneuver as the first line of treatment for Benign Paroxysmal Positional Vertigo (BPPV). If your symptoms don’t improve, it’s important to consult with your healthcare provider.