Treatment of anterior canal benign paroxysmal positional vertigo by a prolonged forced position procedure

This report presents a therapeutic procedure for refractory benign paroxysmal positional vertigo (antBPPV) of the anterior canal. Two patients with refractory antBPPV were treated by a prolonged forced position procedure (PFPP). The technique is based on the assumption that the pathophysiological mechanism of antBPPV is similar to that generating posterior canal canalolithiasis. The patients recovered from refractory antBPPV after one or more PFPPs. The rationale for this therapy is that when the patient lies in the proposed forced position, the affected anterior canal is uppermost in an almost gravitationally vertical position. If the patient remains in this position for several hours, the floating particles lying in the non-ampullary arm of the canal can gradually slip out of the canal towards the vestibule due to gravity. We recommend trying PFPP when the side of lithiasis cannot be determined, in cases that are resistant to particle repositioning canal manoeuvres, and before considering canal plugging for refractory antBPPV.