A patient reports vertigo and nausea after rolling in bed. The symptoms last for 30 seconds. The patient has a positive Hallpike-Dix test. To decrease symptoms, which intervention would be MOST effective?

• A. Habituation exercises
• B. Brandt-Daroff exercises
• C. Gaze stabilization treatment
• D. Canalith repositioning treatment

Answer: (D)

In BPPV, the most effective treatment is a repositioning maneuver that moves the displaced otoconia out of the semicircular canal and back into the utricle. A positive Hallpike-Dix test points to canalithiasis in the posterior canal, which is exactly what these maneuvers are designed to treat. The canalith repositioning treatment, such as the Epley maneuver, guides the loose stones through the canal and into the utricle, where they no longer trigger the abnormal endolymph flow that causes vertigo. This often relieves symptoms quickly, sometimes after a single session. Other approaches like habituation or Brandt-Daroff exercises aim to reduce vertigo over time but are not as immediately effective for mechanically resolving canalithiasis, and gaze stabilization targets a different vestibular deficit rather than repositioning canaliths.