From the Guidelines
The Canalith Repositioning Procedure (CRP) is a highly effective treatment for benign paroxysmal positional vertigo (BPPV), with success rates of 70-100% after one or two treatments, and should be performed by a healthcare provider or learned by patients to do at home 1.
What is the Canalith Repositioning Procedure?
The Canalith Repositioning Procedure (CRP) is a treatment for BPPV that involves a series of head movements designed to move displaced calcium carbonate crystals (canaliths) from the semicircular canals back to the utricle where they belong in the inner ear.
How is the Procedure Performed?
The procedure typically takes about 15 minutes and is performed by a healthcare provider, though some patients can learn to do it at home. During the procedure, the patient is moved through four positions, holding each for about 30-60 seconds or until vertigo subsides.
What are the Benefits of the Procedure?
The procedure works because gravity helps reposition the displaced crystals as the head is moved through different positions. CRP is highly effective, with success rates of 70-100% after one or two treatments, though some patients may require multiple sessions.
What are the Side Effects of the Procedure?
Side effects are minimal but may include nausea, vomiting, or brief vertigo during the procedure.
Post-Procedure Care
After treatment, patients may need to keep their head upright for 24-48 hours and avoid sleeping on the affected side for a week to prevent crystals from moving back into the canals.
Key Points to Consider
- CRP is a highly effective treatment for BPPV
- The procedure should be performed by a healthcare provider or learned by patients to do at home
- Side effects are minimal
- Post-procedure care is important to prevent crystals from moving back into the canals
- CRP has a high success rate, with 70-100% of patients experiencing relief after one or two treatments 1.
From the Research
Definition and Purpose of Canalith Repositioning Procedure
- The Canalith Repositioning Procedure (CRP) is a non-invasive treatment for Benign Paroxysmal Positional Vertigo (BPPV) 2, 3, 4, 5, 6.
- The procedure involves a series of timed head maneuvers and applied vibration to induce out-migration of free-moving pathological densities in the endolymph of a semicircular canal 6.
- The goal of CRP is to treat BPPV by resolving the nystagmus and positional vertigo associated with the condition 2, 3, 4, 5, 6.
Efficacy of Canalith Repositioning Procedure
- Studies have shown that CRP is an effective treatment for BPPV, with a high success rate in resolving symptoms 2, 3, 4, 5, 6.
- One study found that symptoms subsided immediately in 85% of patients after the first CRP, and only 2% of patients required more than three treatments 2.
- Another study found that a modified Epley maneuver, which includes additional steps and post-treatment instructions, can enhance the efficacy of CRP 5.
Variations and Modifications of Canalith Repositioning Procedure
- There are different variations and modifications of CRP, including the Epley maneuver and the Barbeque maneuver 2, 3, 4, 5.
- Some studies have investigated the efficacy of post-Epley postural restrictions, vestibular rehabilitation exercises, and additional steps in the Epley maneuver 5.
- The evidence suggests that post-Epley postural restrictions can enhance the efficacy of CRP, but the benefit is small and may not be significant for all patients 5.
Patient Selection and Outcomes
- CRP is typically recommended for patients with posterior canal BPPV diagnosed with a positive Dix-Hallpike test 2, 3, 4, 5, 6.
- Patient outcomes can vary depending on factors such as age, history of head trauma, and presence of other neuro-otologic disorders 2, 3, 4, 5, 6.
- Elderly patients and those with a history of head trauma or vestibular neuropathy may have a higher recurrence rate and require additional education and follow-up 2.