Canalith Repositioning Procedure

A canalith repositioning procedure (CRP) is a treatment for benign paroxysmal positional vertigo (BPPV). BPPV is the most common type of vertigo. It causes brief symptoms of vertigo when moving your head and body (like when you lie down, roll over in bed or bend over). The most well-known CRP is the Epley maneuver. It involves a series of head movements that aim to relieve vertigo symptoms.

With BPPV, tiny calcium carbonate crystals, called canaliths, shift from one part of your inner ear to another. They move from the utricle (where they belong) to one of your semicircular canals inside the innermost part of your ear (where they don’t belong). When this happens, changes in your head position can trigger episodes of vertigo.

The Epley maneuver moves the canaliths out of your semicircular canals. It helps reduce BPPV symptoms in about 8 out of 10 people. This is why the Epley maneuver is often the first line of treatment for BPPV.

What happens during the Epley maneuver?

Your healthcare provider will guide you through a series of movements to shift the crystals in your ear back in place. After each key movement, they may ask you to hold the position for about 20 to 30 seconds.

Your healthcare provider will:

1. Turn your head at a 45-degree angle toward whichever ear is causing vertigo.
2. Guide you to lie down quickly with your head slightly off the edge of the exam table in the same position (your vertigo symptoms may worsen during this part of the procedure).
3. Turn your head slowly to the opposite side.
4. Rotate the rest of your body so it’s aligned with your head.
5. Ask you to remain on your side for a few moments.
6. Help you sit upright.

CRP takes about five to 10 minutes to complete. Sometimes, your healthcare provider might have to repeat it a few times to get results.

What should I do after a canalith repositioning maneuver?

There are no post-treatment instructions following canalith repositioning maneuvers. But it’s good to avoid sudden head movements.

Can I do the Epley maneuver on myself?

Yes. Your healthcare provider may teach you how to do the Epley maneuver at home in case your symptoms come back. You’ll sit on the edge of your bed and follow the steps your healthcare provider led you through in their office. For best results, you may need to perform the maneuver three times.

What are the potential benefits and risks of this treatment?

The Epley maneuver treats vertigo symptoms in most people with BPPV. There are very few risks.

But it may not be the best option if you have neck or back injuries, retinal detachment or vascular disease. Your provider will check your medical history beforehand to ensure the CRP is safe.

Following the Epley maneuver, some people experience:

• Nausea
• Intense vertigo
• Vomiting (rare)

How long will it take for me to feel better?

Most people feel relief from BPPV symptoms immediately after a canalith repositioning procedure. For other people, it may take a few days to feel better.

Is there anything I can do to make this treatment easier on me?

The most important thing you can do is learn the correct movements before trying a CRP at home. This is because not doing the movements correctly could make symptoms worse. Ask your healthcare provider to show you how, so you can do it on your own in case symptoms return.

While you can do the Epley maneuver anytime, many people prefer to do it just before they go to sleep. If you have vertigo symptoms after the procedure, you can sleep through them.

When should I call my healthcare provider?

If you’ve already tried the Epley maneuver and still have symptoms, call your provider for help. You may need tests to rule out other causes of vertigo, like ear infections and migraines. Your provider may prescribe nausea or motion sickness medications to ease your symptoms.

What is the difference between a canalith repositioning procedure and the Epley maneuver?

A canalith repositioning procedure involves a series of movements that move crystals (canaliths) out of the part of your inner ear where they don’t belong. This relieves vertigo symptoms.

The Epley maneuver is the most widely used type of canalith repositioning procedure to treat BPPV. But it doesn’t work on other causes of vertigo. Other types of CRPs that treat BPPV include the Semont maneuver and the Brandt-Daroff maneuver.

How many times a day should you do the Epley maneuver for vertigo?

You may need to do it up to three times a day for several days to relieve symptoms if you’re doing the Epley maneuver at home. If symptoms don’t get better, contact a healthcare provider.

How do I know which ear needs an Epley?

As part of your diagnosis, your healthcare provider will do the Dix-Hallpike maneuver. This test shows which ear is causing the vertigo. This will help you know which way to turn your head during each movement of the Epley maneuver.