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Benign Paroxysmal Positional Vertigo Follow-up

  • Author: John C Li, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
Updated: May 06, 2016


Serious complications of canalith repositioning procedure (CRP) are rare.

  • Nausea/vomiting: This is usually not a problem if the procedure is performed slowly with mastoid oscillation. In severely symptomatic or anxious patients, premedication with diazepam (Valium) or prochlorperazine (Compazine) may be used.
  • Failure: Although rare, failure can occur in approximately 3-15% of patients (depending upon the series). If no effect is observed, the recommendation is to repeat the procedure. If not successful, investigate other diagnoses. Residual BPPV usually means that purging of canalithiasis was not complete; therefore, repeat the procedure.
  • Worse vertigo afterward: In the event of worsened vertigo after CRP, consider differential diagnoses as follows:
    • Canal jam occurs when the bolus of canalithiasis becomes stuck at the relatively narrower distal canal (near the apex area). Patients become vertiginous upon moving between position 5 and position 6. The recommendation is to reverse CRP back to position 3 in an attempt to unjam the canaliths.
    • Symptoms of contralateral BPPV or other forms of BPPV occur when the bolus of canaliths becomes sidetracked into another SCC. Involvement of the SCC mimics BPPV of the contralateral PSC. The topic of other canal involvement and cupulolithiasis treatment can be quite complex and is beyond the scope of this chapter.
    • Dispersion is possible. Possibly, once shaken, the canaliths are suspended into solution much like dirt in muddy water. As long as they remain suspended, the patient has no symptoms. When the canaliths finally settle, the vertigo can return.


Prognosis following CRP is usually good. Spontaneous remission can occur within 6 weeks, although some cases never remit. Once treated, the recurrence rate is 10-25%.

A retrospective study by Picciotti et al indicated that in individuals who have experienced BPPV, the risk of recurrence is higher in female patients, older patients, and patients with comorbidities (particularly psychiatric disorders). The persistence rate was significantly higher in persons with posttraumatic BPPV (45.2%) than in those with nontraumatic BPPV (20.5%). The study included 475 patients, including 139 (29.3%) with recurrence of BPPV.[7]


Patient Education

For patient education resources, see the Brain and Nervous System Center, as well as Benign Positional Vertigo, Vertigo, and Dizziness.

Contributor Information and Disclosures

John C Li, MD Private Practice in Otology and Neurotology; Medical Director, Balance Center

John C Li, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Neurotology Society, American College of Surgeons, American Medical Association, American Tinnitus Association, Florida Medical Association, North American Skull Base Society

Disclosure: Received consulting fee from Synthes Power Tools for consulting.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Peter S Roland, MD Professor, Department of Neurological Surgery, Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, Director, Clinical Center for Auditory, Vestibular, and Facial Nerve Disorders, Chief of Pediatric Otology, University of Texas Southwestern Medical Center; Chief of Pediatric Otology, Children’s Medical Center of Dallas; President of Medical Staff, Parkland Memorial Hospital; Adjunct Professor of Communicative Disorders, School of Behavioral and Brain Sciences, Chief of Medical Service, Callier Center for Communicative Disorders, University of Texas School of Human Development

Peter S Roland, MD is a member of the following medical societies: Alpha Omega Alpha, American Auditory Society, The Triological Society, North American Skull Base Society, Society of University Otolaryngologists-Head and Neck Surgeons, American Neurotology Society, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Otological Society

Disclosure: Received honoraria from Alcon Labs for consulting; Received honoraria from Advanced Bionics for board membership; Received honoraria from Cochlear Corp for board membership; Received travel grants from Med El Corp for consulting.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

Additional Contributors

Michael E Hoffer, MD Director, Spatial Orientation Center, Department of Otolaryngology, Naval Medical Center of San Diego

Michael E Hoffer, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Received royalty from American biloogical group for other.


John Epley, MD Director, Portland Otologic Clinic

John Epley, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, and Oregon Medical Association

Disclosure: Nothing to disclose.

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The patient is placed in a sitting position with the head turned 45° towards the affected side and then reclined past the supine position.
The patient is then brought back up to the sitting position.
Next, the patient is rolled 180° from the affected side to the opposite side. Note that the position of the head is 45° toward the affected side before the roll. The head winds up facing down, 180° away from the starting position.
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