What are possible complications of canalith repositioning procedure (CRP) for the treatment of benign paroxysmal positional vertigo (BPPV)?

Updated: Mar 13, 2020
  • Author: John C Li, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Serious complications of canalith repositioning procedure (CRP) are rare.

  • Nausea/vomiting: This is usually not a problem if the procedure is performed slowly with mastoid oscillation. In severely symptomatic or anxious patients, premedication with diazepam (Valium) or prochlorperazine (Compazine) may be used.

  • Failure: Although rare, failure can occur in approximately 3-15% of patients (depending upon the series). If no effect is observed, the recommendation is to repeat the procedure. If not successful, investigate other diagnoses. Residual BPPV usually means that purging of canalithiasis was not complete; therefore, repeat the procedure.

  • Worse vertigo afterward: In the event of worsened vertigo after CRP, consider differential diagnoses as follows:

    • Canal jam occurs when the bolus of canalithiasis becomes stuck at the relatively narrower distal canal (near the apex area). Patients become vertiginous upon moving between position 5 and position 6. The recommendation is to reverse CRP back to position 3 in an attempt to unjam the canaliths.

    • Symptoms of contralateral BPPV or other forms of BPPV occur when the bolus of canaliths becomes sidetracked into another SCC. Involvement of the SCC mimics BPPV of the contralateral PSC. The topic of other canal involvement and cupulolithiasis treatment can be quite complex and is beyond the scope of this chapter.

    • Dispersion is possible. Possibly, once shaken, the canaliths are suspended into solution much like dirt in muddy water. As long as they remain suspended, the patient has no symptoms. When the canaliths finally settle, the vertigo can return.

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