This is performed to treat BPPV (Benign Paroxysmal Positional Vertigo). It is used to slowly rotate loose (tiny) calcium debris in the inner ear (semicircular canal) to an area of the inner ear where they do not cause vertigo

Pre-medication to prevent nausea or vomiting is not necessary. The patient begins the procedure in a sitting position. The head is turned toward the affected side.

The patient is then slowly reclined flat with the head turned to the side that induces vertigo.

The patient’s head is slowly turned to the opposite side and the body rolled such that the shoulders are aligned perpendicularly to the floor (affected ear up). The head is then turned further so that the nose points 30 degrees below the plane of the chair. This usually takes another 40 seconds.









If no nystagmus is seen, the patient is then raised back to the sitting position. Finally, the head is turned back to the midline. These positions are demonstrated in the diagrams above. After the procedure the patient is instructed to avoid agitation of the head for about 48 hours while the particles settle. Patients should sleep with their head elevated at 30° ie in an armchair, and avoid sleeping on that side for 5 days.

If done correctly, the calcium particles should flow from the start position (the nerve filled ampulla of the posterior semicircular canal) to the end position (the vestibule in which the particles cannot irritate any nerve structures).

It is important to perform the procedure slowly, slow enough ideally not to generate any rotatory nystagmus.