What is Canalith Repositioning Procedure (CRP)?
BDS (Bachelor of Dental Surgery), 10 years of experience
What is the meaning of the Canalith Repositioning Procedure?
The canalith repositioning procedure is used in the treatment of Benign Paroxysmal Positional Vertigo (BPPV). BPPV is a condition in which a person experiences brief episodes of dizziness. It is the most common cause of vertigo. In addition, the person feels his head is spinning when he or she moves his or her head.
The otolith organs, which are the utricle and saccule, present in the inner ear are responsible for the sensitivity to gravity and the movements of the head and hence, essential to maintain the balance of the body. BPPV occurs due to the displacement of calcium carbonate crystals (also called canaliths) of the otolith organs into the semicircular canals (three fluid-filled, tiny tubes in the inner ear) of the ear. In the canalith repositioning procedure, the otolith crystals are removed from the semicircular canal and repositioned into the utricle.
Let us talk in detail about the canalith repositioning procedure in today’s article.
- What is the purpose of Canalith Repositioning Procedure (CRP)?
- What are the advantages of Canalith Repositioning Procedure?
- When is a Canalith Repositioning Procedure not recommended?
- What is the diagnostic procedure before Canalith Repositioning Procedure?
- What is the preparation for a Canalith Repositioning Procedure?
- What is the procedure of CRP?
- How to care after Canalith Repositioning Procedure?
- What are the risks of Canalith Repositioning Procedure?
- What is the outcome of Canalith Repositioning Procedure?
- What is the cost of Canalith Repositioning Procedure in India?
What is the purpose of Canalith Repositioning Procedure (CRP)?
Canalith repositioning procedure can be done based on the condition and symptoms of Benign Paroxysmal Positional Vertigo (BPPV). It is generally performed to relieve the following symptoms of BPPV:
- Feeling of head spinning
- Dizziness. ( Know more about- What are Cerebrovascular Diseases? )
- Lack of balance ( Know more about- What is Parkinson’s Disease? What is Deep Brain Stimulation Therapy? )
- Nausea
- Vomiting
- Abnormal and frequent eye movements
- Severe headache ( Know more about- What is Brain Aneurysm Surgery? )
- Double vision
What are the advantages of Canalith Repositioning Procedure?
- Canalith repositioning procedure is a unique medical procedure that does not require any special equipment or tools, except an examination table.
- It is a non-invasive procedure. After determining the position of the canaliths, the patient is led by the doctor through a few correct series of movements to get quick relief.
When is a Canalith Repositioning Procedure not recommended?
The canalith repositioning procedure is not recommended in the following cases:
- Certain blood vessel (vascular) disorders like high blood pressure
- Esophageal reflux disease (a condition in which the stomach acid persistently flows back up into the mouth through the food pipe)
- Detached retina (a serious eye condition in which the retina, which is the layer of tissue in the back of the eye, pulls away from the tissues that support it)
What is the diagnostic procedure before Canalith Repositioning Procedure?
Before the canalith repositioning procedure, the doctor may perform the following tests on the patient:
- Physical examination: The doctor will physically examine the patient and determine if the patient is a good candidate for CRP. The patient’s medical history is noted, along with the symptoms of the patient.
- Dix-Hallpike test: BPPV can be diagnosed by electronystagmography (ENG) or the Dix-Hallpike test that uses electrodes to determine irregular eye movements in different head positions. The patient is laid back on the examination table in such a way that canaliths, if present, will trigger vertigo and nystagmus (involuntary, repetitive, rapid eye movements). If the test is positive, it will help in determining whether the canaliths are present in the right or left ear, and where they are present. This helps in the determination of the exact movements that will be helpful during CRP. This test takes about 15 minutes to perform and the patient may be given anti-nausea medication before the procedure.
- Imaging tests: Imaging tests such as CT scans and MRI scans can be performed to obtain clear images of the ear.
What is the preparation for a Canalith Repositioning Procedure?
- The procedure does not require any special preparations.
- Wear comfortable clothes during the procedure, that will allow you to move about freely through each of the maneuvers.
- Inform your doctor of any medical conditions that you may be having before the procedure.
- If you have a neck or back condition, or advanced rheumatoid arthritis (an inflammatory condition that affects the joints and internal organs of the body) before the procedure, you may have to delay CRP.
- The doctor may give some anti-nausea drugs before the procedure.
What is the procedure of CRP?
- Canalith Repositioning Procedure helps to move the particles from the semicircular canal back to the otolith organ.
- It is a simple procedure including a series of head position changes performed by a specialist like a physiotherapist.
- The eye movements are continuously observed by the doctor while performing this procedure.
- There are two techniques of performing CRP. The choice of maneuver depends on the results of the Dix-Hallpike test that determines the semicircular canal in which otoconia (crystals of the otolith organ) have displaced.
- The procedure takes about 15 minutes to complete and can be learned and done at home till the symptoms disappear.
- The two different techniques are:
Epley maneuver:
- The patient is seated and the doctor turns the head 45 degrees horizontally towards the ear that is affected. The patient can hold the doctor’s arm for support.
- The doctor will then tilt the patient back to a horizontal position with the head kept in place at a 45-degree angle.
- A vertigo attack is likely to occur as the debris moves towards the canal’s apex.
- The patient is held in this position till the effect of vertigo stops, which is usually within one minute. ( Know more about- What is Vertigo? Treatment of Vertigo?)
- The doctor will then turn the head of the patient at 90 degrees towards the unaffected ear.
- The doctor will then roll the patient onto the unaffected ear side so that the patient is now looking at the floor.
- The debris will move in the canal again, possibly leading to another vertigo episode.
- The patient stays in this position till the vertigo effect stops, normally within one minute.
- The doctor will help the patient go back to his/her seating position.
Semont-Liberatory maneuver:
- The patient is seated and the doctor turns the patient’s head halfway between looking straight ahead and looking away from the worst affected side.
- The doctor will then quickly lower the patient to the side causing the worst vertigo.
- The head of the patient is on the table, and the patient is looking up at the ceiling.
- The patient is held in this position for 30 seconds.
- The doctor quickly moves the patient to the other side of the table, without stopping at the upright position.
- The head of the patient is now on the table, and the patient is looking down at the table.
- The patient is held in this position for 30 seconds.
- The doctor will help the patient go back to his/her seating position.
How to care after Canalith Repositioning Procedure?
- After the canalith repositioning procedure, the patient is required to keep the ear level above the shoulder. Therefore, the patient should not lie flat for at least one day and keep the head elevated using a reclining chair or pillow.
- The doctor may teach the position of maneuver to the patient, and then these exercises have to be practiced at home until vertigo stops completely.
- If the patient still experiences the symptoms of vertigo, then talk to the doctor.
What are the risks of Canalith Repositioning Procedure?
The risks involved in Canalith Repositioning Procedure are as follows:
- Nausea
- Dizziness ( Know more about- What is Dizziness? Home Remedies for Dizziness )
- Weakness
- Lightheadedness
- Neck or back injury
- Movement of the crystals to an unintended place, which could continue your vertigo episode
If the person experiences any irregularities after the procedure, then contact the doctor immediately.
What is the outcome of Canalith Repositioning Procedure?
- The canalith repositioning procedure is highly effective.
- It is known to cure vertigo in approximately 85 percent of the cases in which it has been used.
- Although recurrence is rare, the doctor may have to repeat the procedure if the symptoms return.
What is the cost of Canalith Repositioning Procedure in India?
The total cost of canalith repositioning procedure in India can range from around INR 1,80,000 to INR 2,10,000. However, many prominent hospitals and doctors in India specialize in canalith repositioning procedures. But the cost varies across different hospitals.
If you are coming from abroad, apart from the cost of canalith repositioning procedure, there will be an additional cost of living in a hotel and the cost of local travel. After surgery, the patient is kept for one day in the hospital and fifteen days in the hotel for recovery. So, the total cost of canalith repositioning procedure in India comes to be around INR 2,20,000 to INR 2,60,000.
We hope that we could answer your questions regarding the canalith repositioning procedure through this article.
If you need more information about the canalith repositioning procedure, you can contact the ENT Specialist.
We only aim to give you information through the article. We do not recommend medication, treatment in any way. Only a doctor can give you the best advice and correct treatment plan.
