Superior and Horizontal Canal BPPV – what are those?

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Someone recently asked about the treatment for the other 2 canals in the inner ear and if the Epley maneuver work for those types of BPPV.

The quick answer is no the Epley maneuver does not work for horizontal or superior canal BPPV but only for the more common posterior canal form of BPPV. The good news about that, however, is that those other two types are easier to treat.

First – superior canal BPPV is theoretical and may not actually exist in any significant clinical form. This is because BPPV is caused by the settling of lose “otoconia” in the inner ear. This can only happen in the lowest areas of the inner ear. For example – dust does not settle on the ceiling, rather it settles on the floor. The same is true of the inner ear. The particles settle, typically in the posterior canal because it is the lowest area and it is not tipped upside down by regular activity. By contrast – the superior canal is emptied every time you lie down and stand up. So, while it is possible to have crystals in that canal, it is not possible to have then “get stuck” there and cause BPPV.

The same is true, to some degree, with the horizontal canal. Whenever you roll over (like a log roll) the canal is emptied. So many times simply sleeping at night (when you may roll over) is curative for that condition. It is, however, more intense vertigo than posterior BPPV. It is worth noting that horizontal BPPV can sometimes be induced by the treatment maneuvers for posterior BPPV as the crystals may fall out of the posterior canal and temporarily fall into the horizontal canal.

Finally, posterior BPPV is the most common kind as the anatomy of the canals allows for collection of the crystals in the lowest part of the ear. In addition, neither rolling over nor lying down and getting up again will cause the crystals to empty out. The main treatment for this condition is the “particle repositioning maneuver” or Epley maneuver.

If you are having symptoms which don’t fit the norm make sure you discuss them with your own physician.