Canalith Repositioning Procedure

1. Indication
   1. Benign Paroxysmal Positional Vertigo (BPPV)
2. Contraindications
   1. Severe Carotid Stenosis
   2. Unstable heart disease
   3. Cervical Spondylosis with myelopathy
3. Mechanism
   1. Reposition debris in labyrinth back into vestibule
   2. Debris starts in posterior semicircular canal
   3. Debris moves into utricle with procedure
4. Technique (Described for right ear, reverse for left)
   1. Patient sits upright facing examiner on right
      1. Patient holds onto examiners Forearms for stability
      2. Slowly lower patient to supine position
      3. Allow head to extend over the edge of the table
      4. Keep right ear downward
      5. Continue this position until Nystagmus resolves
   2. Examiner moves to head of table
      1. Examiner repositions hands to each side of head
   3. Rotate patient's head to left
      1. Head extended over edge of table
      2. Right ear upward
      3. Continue this position for 30 seconds
   4. Patient rolls onto left lateral decubitus position
      1. Rotate head leftward until nose is angle toward floor
      2. Continue this position for 30 seconds
   5. Assist patient to sitting position, facing left
   6. Repeat procedure until no Nystagmus on exam
5. Post-Repositioning Procedure Instructions
   1. Turn head and neck as one unit for first week
   2. Sleep reclined at 45 degrees for first 2 nights
      1. Recliner
      2. Pillows propped under head
   3. Do not sleep on affected side for the next 5 nights
      1. Put tennis ball in pocket on that side
      2. Pin pillow to affected side
   4. Return for symptom recurrence
      1. Procedure may need to be repeated
6. Efficacy
   1. Resolution in 50% of patients versus 19% for Placebo
   2. References
      1. Froehling (2000) Mayo Clin Proc 75:695-700
7. References
   1. Bernard (1996) Am Fam Physician 53:2613-6
   2. Epley (1992) Otolaryngol Head Neck Surg 107:399