Positional Vertigo

Canalith Repositioning Maneuver for Positional Vertigo

Article Submission by Dr. Lawrence Huntoon, especially for MediBid.com 6/14/11

Positional VertigoBenign paroxysmal positional vertigo (BPPV), also known as positional vertigo, is a common condition that can cause very uncomfortable symptoms.  Patients often experience a spinning sensation (vertigo) when they roll over in bed, bend down to pick something up off the floor, tip their head back or turn their head quickly either right or left.  The spinning sensation typically lasts only a matter of seconds and can be accompanied by nausea and loss of balance. 


Physicians diagnose positional vertigo using a simple clinical test known as the Dix-Hallpike maneuver. The test involves turning the patient’s head and allowing the patient’s head to hang over the edge of the examination table.  A positive test is one that elicits brief vertigo.  The test allows the physician to confirm a suspected diagnosis of positional vertigo, to determine which ear is affected, and to determine which canal in the inner ear is affected.


Positional vertigo is caused by loose debris, calcium carbonate particles known as canaliths, in the inner ear.  The inner ear has two components – a hearing component, known as the cochlea, and a balance component, known as the labyrinth.  The labyrinth has three fluid-filled semicircular canals in each inner ear – the anterior, posterior and horizontal canal.  Positional vertigo most often affects the posterior semicircular canal.  When a patient turns his head or tips his head back, loose canalith particles move with the fluid in the semicircular canal and come into contact with special sensory hairs.  When these loose particles come in contact with these special sensory hair cells, they produce a sensation of vertigo. 


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Fortunately, positional vertigo is easily treatable.  The canalith repositioning procedure (CRP) uses head movements and gravity to reposition the canalith particles and move them in to a portion of the inner ear where they will not cause vertigo.  Canalith particles then dissolve over the course of about six months.  The canalith repositioning procedure has a success rate of about 80%, meaning that 80% of the time the procedure resolves positional vertigo.  The recurrence rate of positional vertigo is about 25% for the first year and 44% for the second year.  If positional vertigo recurs, the procedure can be performed again.  In fact, following initial diagnosis, and at the physician’s discretion, patients can be trained to perform the procedure on themselves as needed. 


CRP is simple, painless, cost effective and has a very high success rate.  No expensive tests or medications are required to treat positional vertigo.  Although CRP is subject to rationing and denial of care in the Medicare program and other insurance programs, physicians who have enrolled in Medi-Bid can offer this highly effective treatment. 


 Lawrence R. Huntoon, M.D., Ph.D., F.A.A.N.

Board-Certified Neurologist

Fellow, American Academy of Neurology

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