17930 Canalith Repositioning Procedure Crp

Overview

The canalith repositioning procedure (CRP) is a gentle, hands-on treatment for a common kind of dizziness called benign paroxysmal positional vertigo, or BPPV for short. In BPPV, tiny chalk-like crystals inside your inner ear slip out of their usual spot and drift into one of the balance canals. When you move your head, these crystals swirl around and send your brain confusing balance signals, so the room seems to spin. During CRP, a doctor or trained clinician guides your head and body through a set of slow, planned movements. These movements use gravity to ease the loose crystals back to a place where they no longer cause dizziness. The best-known version is called the Epley manoeuvre. There are no needles, no medicines and no surgery involved.

BPPV is one of the most common causes of dizziness that brings people to their doctor, and CRP is a routine procedure used in general practice, ear clinics and physiotherapy. So if you have been offered it, you are in very familiar company.

BPPV most often affects adults over 50, and the chance of it goes up as people get older. It can also happen to younger adults, sometimes after a bump to the head. It is uncommon in children.

Symptoms

Common symptoms

• Short bursts of spinning that last less than a minute, set off by changes in head position
• Dizziness when you roll over in bed, look up, or bend forward to pick something up
• Feeling unsteady or seasick after the spinning stops
• Feeling sick or actually being sick during a spell of vertigo
• During the CRP itself: a brief spell of spinning and queasiness while your head is moved, which settles quickly
• For a day or two after treatment: mild wobbliness, a floating feeling, or lingering nausea that usually fades

Symptoms in children

• BPPV is rare in children, so other causes of dizziness are usually checked first
• Young children may not say "spinning" — they might say their head feels funny, feel sick, or refuse to move their head
• They may cling on, avoid rough-and-tumble play, or seem clumsy
• A child with repeated dizziness should always be checked by a doctor

Symptoms in older adults

• Dizziness on turning over in bed or getting up, which is sometimes mistaken for "just getting older"
• A higher chance of losing balance and falling, which matters more with weaker bones
• Fear of falling, leading to moving less and losing confidence
• Symptoms can be harder to describe, and other health problems can make the dizziness feel worse

Causes

Main causes

• Tiny calcium crystals (called otoconia) becoming loose inside the inner ear and drifting into a balance canal
• Often no clear cause is found, which is called idiopathic BPPV
• A knock or injury to the head
• Inner ear inflammation, such as after a viral ear infection
• Long periods lying down, for example during illness, recovery from surgery or bed rest
• Ear surgery, or, less often, other inner ear conditions
• Age-related wear of the balance system

Risk factors

• Being over 50
• A previous head injury, even a mild one
• Having had BPPV before
• Thinning bones (osteoporosis) or low vitamin D levels
• Long stretches of lying down or being inactive
• A family history of BPPV
• Some migraine conditions are linked with dizziness, though the link is not fully understood

When to see a doctor

See a doctor urgently if:

• Dizziness with hearing loss, ear pain, ear discharge or fever
• Dizziness after a head injury
• Severe spinning that lasts hours instead of seconds or minutes
• Repeated vomiting or signs of dehydration
• Any dizziness with stroke-like signs — weakness, numbness, speech trouble or trouble walking (call emergency services first)

Book a routine appointment if:

• Short spells of spinning when you turn over in bed, look up or bend down, especially if they keep happening
• Dizziness that is affecting your sleep, work or confidence
• Any fall, near-fall, or fear of falling
• Unsteadiness that goes on for days or weeks
• Dizziness that has not improved with the treatment you were shown

Diagnosis

Your clinician will start by asking about your dizziness: what sets it off, how long each spell lasts, and what it feels like. Positional vertigo has a very recognisable pattern — seconds of spinning after a head movement. They will then test your balance and watch your eyes for a flickering movement called nystagmus, which is a strong clue that the crystals are in a particular canal. The usual test is called the Dix-Hallpike test: you sit on a couch, and the clinician quickly but gently lays you back with your head turned to one side. If that brings on the spinning and the eye flicker, it points to BPPV. The whole check-up is quick.

Tests that may be done

• Dix-Hallpike test — lying back quickly with your head turned, to see if it triggers symptoms
• Supine roll test — rolling your head side to side while lying flat, used when a different canal is involved
• Watching your eye movements, sometimes with special goggles that make the eye flicker easier to see
• A simple hearing check, since ear conditions can cause dizziness
• Balance and walking assessment, especially in older adults
• Blood tests if a vitamin D or bone health issue is suspected
• In unusual cases, a brain scan or referral to an ear, nose and throat or balance specialist

What to expect at your appointment

The examination is safe but can feel unpleasant for a few moments, because the tests are designed to bring on the dizziness so the clinician can see it. The spinning usually settles within a minute. You may feel queasy afterwards. Some people prefer to have a friend or family member come with them, and to arrange a lift home rather than driving themselves straight after.

Treatment

The canalith repositioning procedure is the main treatment for BPPV and works for most people. Your clinician moves your head and body slowly through a set sequence of positions, holding each one for a short time while gravity guides the loose crystals out of the balance canal. You may feel a brief spin during the sequence — that is expected and usually a sign the right spot has been found. Most people need only one session, though some need two or three, or a repeat course if symptoms return later. There are a few variants of the manoeuvre, and your clinician will pick the one that matches which canal is affected.

Self-care at home

• Follow any home instructions your clinician gives you, including whether to sleep slightly propped up for a night or two
• Move your head slowly and gently for the first day or so
• Sit down straight away if you feel dizzy, and avoid driving until the dizziness has settled
• If you have been taught home exercises, do them exactly as shown, even if they cause brief dizziness
• Keep a note of when symptoms happen, so you can tell your clinician whether treatment is working
• Ask someone to stay nearby for the first day in case you feel unsteady

Medical treatments

The repositioning manoeuvre itself is the treatment, and no medicine cures BPPV. A clinician may sometimes prescribe a short course of medicine to calm nausea or reduce the spinning feeling while you recover, but these ease symptoms rather than fix the cause. If you feel unsteady for a while after the crystals are back in place, a course of vestibular rehabilitation — special balance exercises taught by a physiotherapist — can help your balance system readjust. Your clinician will review you if symptoms persist, and may repeat the manoeuvre or try a different version of it.

When is surgery considered?

Surgery is very rarely needed. If BPPV keeps coming back, affects one ear again and again, and does not settle with repeated repositioning procedures, an ear, nose and throat specialist may discuss a small operation to block the affected balance canal. This is uncommon and only considered after other options have been tried.

Living with this condition

Most people recover quickly after treatment, but it is sensible to take things gently for a few days. Move your head more slowly than usual, sit down if the room starts to spin, and use good lighting and handrails at home if you feel unsteady. Tell someone close to you about your symptoms so they can keep an eye out. If your job involves heights, driving or dangerous machinery, check with your clinician before going back to it.

Lifestyle tips

• Keep active within what feels safe — gentle walking helps your balance system settle
• Avoid sudden head movements such as quick looks up or over your shoulder for the first few days
• Set up your home to reduce falls: good lighting, clear pathways, a night light, and nothing to trip over
• Rise slowly from lying to sitting to standing
• If you have been falling, ask about a balance and falls assessment
• Look after your bone health, since falls matter more if bones are thin

Diet and exercise

There is no special diet for BPPV. Eating and drinking normally matters mainly to prevent dehydration if nausea stops you keeping fluids down — sip water little and often. Some research suggests that correcting low vitamin D may reduce how often BPPV comes back, so it is worth asking your clinician whether a vitamin D check is right for you; do not start supplements on your own without advice. Gentle exercise such as walking, tai chi or the balance exercises your clinician teaches can improve steadiness and confidence. Avoid head-down positions like some yoga poses until you have recovered.

Mental health and emotional wellbeing

Dizziness can be surprisingly unsettling. The world feels unreliable, and it is common to feel anxious, to avoid certain movements, or to lose confidence in going out. That worry is understandable, and it usually eases as the dizziness settles. If low mood or anxiety is building up, or you find yourself avoiding more and more, tell your doctor — talking therapies and support are available. If you ever feel overwhelmed or unsafe in your thoughts, contact your local crisis support service or emergency number straight away.

Prevention

You cannot always prevent BPPV, because the crystals can loosen for no clear reason. But some things may lower your chance of it coming back: looking after your bone health, asking your clinician about a vitamin D check if you have had repeated episodes, avoiding long stretches of bed rest when you can, and rising from bed slowly. If BPPV does return, the same repositioning procedure usually works again.

Screening programmes

There is no routine screening test for BPPV. It is found by examining people who have symptoms. If you have had BPPV before, it is worth knowing the pattern — short spins on turning in bed — so you can get checked quickly if it returns.

Complications

If left untreated

• Falls and injuries, which matter most for older adults and people with thin bones
• Ongoing unsteadiness that affects work, driving and everyday tasks
• Nausea and, in severe cases, dehydration from not keeping fluids down
• Anxiety, low mood and avoiding activities because of a fear of spinning or falling
• Lost confidence and reduced activity, which can make balance weaker over time

Long-term outlook

The outlook is good. The canalith repositioning procedure works well for most people, often within one or two sessions, and many feel back to normal within days to a couple of weeks. Some people do get BPPV again later, months or years down the line, but a repeat procedure usually settles it. If you still feel unsteady after treatment, tell your clinician — there is usually more that can be done, including balance exercises and review by a specialist.

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