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https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/vestibular/conditions/benign_paroxysmal_positional_vertigo.html

Hopkins Treatment

The treatment of BPPV is based upon our specific knowledge of the disease. Bedside physical therapy maneuvers and programs of exercise have been designed with the goal of removing the stones from the semicircular canals. Once out of the semicircular canals, the stones are probably absorbed naturally over the course of days to weeks. There is always the risk of the stones falling back into the semicircular canal and getting stuck again. Once out, however, the otoconia usually don’t cause further problems. If the stones do fall back into the semicircular canal, the physical therapy can be repeated.

The physical therapy maneuver we usually use is called the Epley maneuver. First, while sitting up, the patients head is turned about 45 degrees to the side that normally provokes the vertigo. Then the patient is quickly laid down backwards with their head just over the edge of the examining table. This position usually provokes strong vertigo. The head is kept in this position for about 30 seconds and then turned 90 degrees to the opposite side. After another 30 seconds, the head and the body are turned together in the same direction so that the body is pointing towards the side, and the head is pointing down toward the ground at a 45 degree angle. After 30 seconds in this position, the patient is brought upright again. This is repeated as many as five or six times until neither vertigo nor nystagmus are elicited when the head is brought into the bad ear down position.

In some cases, a hand held vibrator is applied to the bone behind the bad ear to help dislodge the stones that may have become stuck on the walls of the semicircular canal.
Follow-Up Instructions

After the maneuver, the patient is asked to sit still with their head upright for ten-to-twenty minutes.
Begin walking with caution
Avoid putting head back, or bending far forward (for example, to tie shoes) for the remainder of the day
Avoid sleeping on the side of the affected ear for several days

Usually no medications are required for BPPV unless the patient has severe nausea or vomiting. If extreme nausea does exist, anti-nausea medications can be prescribed before and/or after the treatment.

In about 70-80 percent of patients, a cure is immediate. In 20-30 percent, the symptoms recur within the first week and the patient should be treated again. Over the long term, BPPV recurs about half of the time. Usually the symptoms are less severe, and re-treatment is simple and effective. In patients with frequent recurrence, exercise programs can be prescribed so the patient can treat themselves.

In rare cases, a surgical procedure can be performed in which the posterior semicircular canal is plugged, preventing the otoconia from moving within the canal. While the surgical plugging procedure cures the problem, it carries some risk – including loss of hearing.

In some cases, one of the canals other than the posterior one is involved. If it is the lateral semicircular canal, slightly different maneuvers are used but still based upon the same principal of moving the stones out of the offending semicircular canal. Sometimes, simply lying with the bad ear up for 12 hours, while not a particularly exciting proposition, allows the stones to fall out of the canal and cures the condition.

BPPV of the anterior canal is exceedingly rare, as debris in this canal (located at the top of the inner ear) easily falls out on its own.

In many ways, the discovery of the mechanism of this simple treatment for BPPV is one of the most gratifying advances in the evaluation of the dizzy patient. BPPV can be diagnosed and treated successfully with no tests, no pills, no surgery and no special equipment.