Abstract
The technique of particle (canalith) repositioning has achieved generalized acceptance for the treatment of canalithiasis (BPPV). Sometimes referred to as the “Epley Maneuvers”, this modality involves head maneuvers designed to reposition the abnormal, vertigo-generating particles from a semicircular canal to the utricle. The simple-appearing protocols have many nuances and complexities that are often not fully appreciated. The author's recent infra-red videography studies, as well as cognizance of others performing the procedure, have revealed certain critical points in which mistakes or omissions are often made. These may negate resolution by allowing the particles to migrate in reverse or to re-enter a canal from the utricle. This article, after reviewing the rationale and technique of particle repositioning (PR), discusses these critical points in depth, as well as the management of complications.
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