What should be done if vestibular function is impaired due to benign paroxysmal positional vertigo (BPPV)?

Benign paroxysmal positional vertigo (BPPV), or “ear stone syndrome,” involving vestibular dysfunction, can be treated via manual repositioning maneuvers or surgical intervention.

Vestibular dysfunction may result from BPPV. This condition typically arises from dislodged otoliths (calcium carbonate crystals) in the inner ear, manifesting as brief episodes of rotational vertigo triggered by specific head positions. Following diagnosis, patients may undergo the Epley maneuver under medical supervision: the patient is rapidly moved from a seated position to a supine position with the head extended over the edge of the examination table (semi-hanging position); the head is then rotated 45° toward the affected side so that the affected ear faces downward; next, the head is rotated another 90° so that the affected ear remains downward; finally, the patient returns to the seated position while keeping the head centered and slightly flexed forward (chin-to-chest). At each step, the patient must remain in position until vertigo subsides before proceeding to the next step. This maneuver generally yields satisfactory results.

If BPPV is refractory—persisting for over one year—and conservative management proves ineffective, significantly impairing daily functioning and quality of life, surgical options may be considered. These include posterior semicircular canal occlusion or posterior ampullary nerve section.