The Fortuitous Beginnings of Canalith Repositioning

I wasn’t always a vestibular geekazoid. In the first several years of practice I “did ENGs” like many others, but soon decided my time was more effectively spent helping those with hearing problems. While the ENG test often found abnormalities, there were no solid treatments to help these people. I backed away and did not see vestibular patients for several years. The article “Physical therapy for benign paroxysmal positional vertigo”  by Brandt and Daroff was the starting point of the resurgence of my interest in vestibular matters. There’s more to that story, but it is best to tell it another day.


The authors of this article proposed a series of exercises that they felt would take advantage of neural compensatory mechanisms to relieve the symptoms of benign paroxysmal positional vertigo (BPPV). They proposed that repeated provocation of symptoms would gradually result in habituation to the symptoms. They had very good success (66 of 67 patients had complete relief of symptoms within 3 to 14 days) but they were suspicious that there must be something else going on. Compensation and habituation don’t work that fast. They reported: “The presumed mechanism for this therapy is the loosening and ultimate dispersion of degenerated otolithic particles from the cupula of the posterior semicircular canal.” In other words, they were doing the first intentional Canalith Repositioning.


With what we now know about BPPV, it would be virtually impossible to habituate. The unpredictable and intermittent nature of BPPV does not facilitate habituation, which depends on a change in response to a repeated or expected stimulus. But, back in 1980, there was still significant speculation about what was going on inside an ear during a BPPV attack.


Shortly after Brandt and Daroff published their article, several researches began working on techniques to take advantage of their findings. Let’s review a bit of this history next week.

Photo courtesy of The Tinnitus Journal


About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.