What happens before a canalith repositioning procedure (CRP)?

A medical examination will determine if the patient is a good candidate for CRP. People with certain health conditions should not undertake the procedure. These conditions include existing inner ear problems that could be made worse with CRP, detached retina, certain vascular (blood vessel) disorders and esophageal reflux disease.

A Dix-Hallpike test is administered to confirm a diagnosis of BPPV. The patient is laid back onto an examination table in such a position that canaliths (crystals), if present, will trigger vertigo and nystagmus. If the test is positive it will also show if the canaliths are in the right or left ear, and where they are within those. This helps determine the exact movements that will help the most during CRP.

The procedure can be performed in a doctor’s office and usually takes about 15 minutes. An anti-nausea medication may be given beforehand.

What happens during a canalith repositioning procedure/treatment?

CRP uses a specific pattern of head and body movements. It must be delivered by an expert in the procedure to exclude those who are not good candidates, and guard against injury during the procedure.

  • Step 1 – The patient is laid on the back onto an examination table, with the head hanging over the back edge of the table. The patient’s head is turned in the direction of the affected side.
  • Step 2 – The patient remains in this position for 30 seconds.
  • Step 3 – The head is turned in the other direction to the unaffected side for 30 seconds.
  • Step 4 – The head is turned again to a nearly face-down position for 30 seconds. The patient’s body will likely have to be repositioned from lying on the back to lying on the side to be able to accommodate this head movement.
  • Step 5 – The patient is brought back to a sitting position. When the patient sits up quickly the canaliths fall out of the canal, back into the middle chamber of the inner ear where they do not cause symptoms.

The exact head movements chosen and the amount of time between movements are based on the location of the crystals within the ear and are determined by the medical team giving the procedure.

What happens after a canalith repositioning procedure (CRP)?

Best practice recommendations strongly advice against post-treatment restrictions after CRP for posterior canal BPPV. There is limited medical evidence to support avoiding head movements, sleeping in a reclined position after treatment or avoiding sleeping over the affected ear for days following treatment. However, some consideration of post-treatment restrictions may be made in some cases such as frequently recurring BPPV.

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