Unilateral Triple Canal Repositioning Maneuver: Principles and Design.

Background: Benign paroxysmal positional vertigo is the most common cause of dizziness over the lifespan. Management is complicated by both a diagnostic burden (correctly interpreting specific ocular motor findings) and a therapeutic burden (selecting appropriately targeted treatment maneuvers). Purpose: Devise a canalith repositioning maneuver to treat simultaneously benign paroxysmal positional vertigo affecting any combination of semicircular canals on one side. If clinically verified, then this will simplify management. Research design: After analyzing the results of a computer simulator applied to several published maneuvers for treating benign paroxysmal positional vertigo, we used basic principles to design a maneuver that simultaneously, for all three semicircular canals on one side, advances otoliths toward the crus of each canal and prevents retreat toward the ampule of each canal and then tested the maneuver in computer simulation. Study sample: Not applicable.

Intervention: Not applicable.

Data collection and analysis: Not applicable. Results: We developed a maneuver that computer simulation predicts will successfully treat simultaneously benign paroxysmal positional vertigo affecting any combination of semicircular canals on one side. Conclusions: This maneuver should be tested empirically as a standalone maneuver and compared to other maneuvers.

Clinical relevance statement: If the efficacy of this maneuver is clinically verified, then it will simplify management by diminishing the diagnostic burden (of determining affected canals) and treatment burden (of selecting the appropriately targeted maneuvers).