During Canalith Repositioning Therapy, The Maneuver Begins In Which Position to Provoke Vertigo?

• A. Supine With Head Turned to the Affected Side
• B. Seated Upright With Forward Bending
• C. Dix-Hallpike Position
• D. Prone

Answer: (C)

The starting step of Canalith Repositioning Therapy is to provoke vertigo by placing the patient in the Dix-Hallpike provocative position. This specific setup uses gravity to move the canaliths within the posterior semicircular canal, which is the canal most commonly involved in BPPV. Begin seated with the head turned toward the affected side, then rapidly lower the patient into a supine position with the head extended about 20 degrees. In this orientation, the posterior canal is aligned with gravity, causing the otoconia to shift and trigger the characteristic vertigo and nystagmus that confirm canal involvement and set up the subsequent steps of the maneuver. Other positions do not optimally provoke the posterior canal in the same way and are not used to start the therapy.