Head Turned 45° Toward the Affected Ear
Starting posture aligns the posterior canal with the plane of movement.
- 45°: Head rotation (toward affected ear)
- Seated: Posture (upright on table edge)
- Posterior: Canal aligned (semicircular canal)
- ~1–2s: Duration (brief starting hold)
Why this starting angle
Placeholder: aligns canal plane with the vertical repositioning axis.
Placeholder: correct starting angle is confirmed by Dix-Hallpike testing.
Rapid Recline to Supine With Head Extended
Gravity begins pulling otoconia along the canal toward the common crus.
- 20°: Head extension (below table level)
- Rapid: Transition speed (minimizes symptom lag)
- Peaks here: Nystagmus (torsional, upbeating)
- ≥30s: Hold target (until symptoms settle)
Gravity-driven migration begins
Placeholder: crystals start moving toward the canal exit under gravity.
Placeholder: this position typically provokes the strongest vertigo.
Head Turned 90° to the Opposite Side
Continued rotation moves crystals further along the canal arc.
- 90°: Head rotation (toward unaffected side)
- 135°: Cumulative turn (from initial position)
- Mid-arc: Canal position (approaching common crus)
- ≥30s: Hold target (per position)
Mid-sequence repositioning
Placeholder: otoconia traverse the widest part of the canal loop.
Placeholder: symptoms usually diminish compared to position 2.
Body and Head Rotated Further, Facing Down
Rolling onto the shoulder brings crystals to the canal opening.
- ~135°: Body roll (onto unaffected shoulder)
- Downward: Face orientation (toward floor)
- Reached: Canal exit (near common crus opening)
- ≥30s: Hold target (before sitting up)
Approaching the utricle
Placeholder: crystals near the exit into the utricular cavity.
Placeholder: careful slow movement avoids crystals re-entering canal.
Sit Up — Otoconia Repositioned Into the Utricle
Slow return to upright deposits crystals safely in the utricle.
- Upright: Final posture (seated, chin tucked)
- Utricle: Crystal location (no longer canal-active)
- ~80%: Success rate (single-session placeholder)
- Recommended: Follow-up (repeat if symptoms persist)
Completion of the maneuver
Placeholder: repositioning complete; monitor for residual symptoms.
Placeholder: a Brandt-Daroff exercise may reinforce results.