This disease is not treated with drugs or home remedies, but with a mechanical treatment consisting of maneuvers and exercises.


What to do? Treatment for Benign Paroxysmal Positional Vertigo (BPPV)


Releasing maneuvers for positional paroxysmal vertigo of the posterior semicircular canal

There are two very effective treatments for BPPV (or canalolithiasis), with a recovery rate of about 80%.
This disease is caused by an abnormal position of the otoliths (pebbles) in the semicircular canals.
The maneuvers serve to move the otoliths from the sensitive part of the ear (posterior channel) to a position where they do not cause problems.
Each maneuver lasts about 15 minutes.

The Epley maneuver  involves sequential head movements in four positions, with a stay of about 30 seconds in each position:

1) Initial position, patient sitting in bed.
2) The patient lies with the head beyond the edge of the bed and rotates the head of 45 ° toward the side of the affected ear. The doctor extends the patient’s head slightly (20 °) and maintains this position for 30 seconds.
3) The doctor quickly turns the patient’s head toward the opposite side, but the patient’s position remains the same.
4) The doctor turns the patient’s head further until he looks at the floor.
5) The patient returns to sit on the bed.
While performing the Epley maneuver, great care is recommended because it can cause neurological symptoms (eg, weakness , numbness, visual changes).
Sometimes these symptoms are caused by the compression of the vertebral arteries.

Epley’s maneuver for positional paroxysmal vertigo


The Semont maneuver for diagnosis and treatment.

Semont Maneuver

The semont-releasing maneuver  is a technique in which the doctor moves the patient quickly from one side of the bed to the other.
It is a maneuver that can solve the problem in 4 sessions of treatment in approximately 90% of the cases.

Initial position
Patient is sitting with legs out of bed.
The head should always be turned 45 ° to the right.

Performing the maneuver
The doctor quickly tosses the patient to the left side; if they appear nystagmus or vertigo means that the diseased ear is the left.
In this case, the treatment (Semont maneuver) is performed by placing the patient on the opposite side, holding this position until the dizziness passes (2-3 minutes).

How to sleep after doing the liberating maneuvers?

After the otolith repositioning sessions, the patient should sleep in a semi-occluded position (the bed head is elevated at a 45 ° angle) for two nights.


Releasing maneuvers for paroxysmal positional vertigo of the lateral semicircular canal

The purpose of this maneuver can be:

  • Remove the otoliths from the ampoule,
  • Move the otoliths from the anterior branch to the posterior branch of the lateral semicircular canal. In this case, the nystagmus changes from apogeotropic to geotropic.

According to a scientific study (Mandala M, Pepponi E, Santoro GP, et al., Double-blind randomized trial on the efficacy of the Gufoni maneuver for treatment of lateral channel BPPV, Laryngoscope 2013, 123: 1782-6), the maneuver of Gufoni is very effective.
It is made for geotropic nystagmus (beating down) to the opposite side and also for apogeotropic nystagmus (which beats up) to the same side.

Patient position

Patient sitting on bed with knees bent over edge and feet dangling.

Execution of the maneuver

  • The examiner grasps the patient’s neck and quickly takes the patient to the lying down position.
  • From here the patient’s head rolls down.
  • It is necessary to wait about two minutes or until the dizziness and the nystagmus passes.
  • Then the patient returns quickly to the sitting position.


According to scientific studies, regular running of the Brandt-Daroff exercise reduces healing times by  10-14 days.
However, the purpose of this exercise was the addiction and compensation of the vestibular system .


Positive paroxysmal vertigo of the anterior semicircular canal

The Deep head hanging or Jacovino maneuver is used to release the anterior or superior semicircular canal.

Initial position
The patient is sitting with his legs along the bed.

Execution of the maneuver

  • The patient is lying on the bed with the head beyond the edge, at maximum extension (folded back),
  • Wait until vertigo and nystagmus pass,
  • In the same position, bring the head to the position of maximum flexion,
  • Wait approximately 60 seconds for the disappearance of nystagmus and dizziness.

Exercises for Benign Positional Paroxysmal Vertigo

Rehabilitation at home
Regardless of the channels involved, the Brandt-Daroff exercise can be useful:

  • When the repositioning maneuvers do not work,
  • If patients do not tolerate maneuvers.

Execution of the Brandt-Daroff maneuver

The patient should:

  • Lie down quickly on your side,
  • Sit down,
  • Lie down on the other side,
  • Sit down.


Each position should be maintained for at least 30 seconds.
These exercises are repeated in series, 5-10 times a day, until the symptoms disappear.

How long is benign paroxysmal positional vertigo?

BPPV is usually a temporary illness and can go away over time without treatment.
According to a report on the natural course of untreated BPPV:

1. If the otoliths are in the lateral canal, usually the person will heal in 16-19 days,
2. If the otoliths are located in the posterior canal, the disorder usually passes in 39-47 days ( Review article: reflux and its consequences-the laryngeal, pulmonary and oesophageal manifestations ).

However, a correct diagnosis and the correct release maneuvers allow you to heal quickly and easily.

Recurrence of vertigo
Vertigo may occur again after healing.
According to a scientific study, in a period of 10 years half of the patients have at least one recurrence (Brandt T, Huppert D, Hecht J, Karch C, Strupp M. Benign paroxysmal positioning vertigo: a long-term follow-up (6-17 years) of 125 patients, Acta Otolaryngol 2006; 126: 160-163).

It usually happens again in the first year.

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