The Canalith Repositioning Procedure: For Treatment of Benign Paroxysmal Positional Vertigo

TLDR

The Canalith Repositioning Procedure (CRP) treats benign paroxysmal positional vertigo by inducing out‑migration of free‑moving pathological densities in the endolymph of a semicircular canal through timed head maneuvers and applied vibration. This article aims to describe the CRP and its rationale while reporting outcomes in 30 patients exhibiting classic BPPV nystagmus. CRP is performed by executing specific head‑maneuver sequences combined with vibration to reposition canaliths within the semicircular canal. CRP achieved complete resolution of nystagmus and positional vertigo in all patients, with 10% experiencing atypical symptoms, 30% having recurrences that responded to retreatment, supporting the theory of free canaliths and demonstrating advantages over other modalities.

Abstract

The Canalith Repositioning Procedure (CRP) is designed to treat benign paroxysmal positional vertigo (BPPV) through induced out-migration of free-moving pathological densities in the endolymph of a semicircular canal, using timed head maneuvers and applied vibration. This article describes the procedure and its rationale, and reports the results in 30 patients who exhibited the classic nystagmus of BPPV with Hallpike maneuvers. CRP obtained timely resolution of the nystagmus and positional vertigo in 100%. Of these, 10% continued to have atypical symptoms, suggesting concomitant pathology; 30% experienced one or more recurrences, but responded well to retreatment with CRP. These results also support an alternative theory that the densities that impart gravity-sensitivity to a semicircular canal in BPPV are free in the canal, rather than attached to the cupula. CRP offers significant advantages over invasive and other noninvasive treatment modalities in current use.