What are anterior canal and multi-canal BPPV, and how are they treated when standard tests fail?

Why is anterior canal BPPV tricky to diagnose?

Anterior canal BPPV is uncommon and produces downbeating nystagmus, sometimes with a slight twist, in head-hanging positions. Central positional nystagmus from the cerebellum or brainstem can look similar. Clues for a central cause include nystagmus that does not fade, little vertigo despite strong nystagmus, and other neurological signs. If the picture is not clear-cut, we refer you to your physician or a neurologist before treating.

What is multi-canal BPPV?

Crystals can sit in more than one canal, such as the posterior and horizontal canals, or in both ears. This is more common after head injury². Each canal is treated in turn, usually starting with the one causing the most symptoms, with retesting in between.

How are anterior and multi-canal BPPV treated?

For anterior canal BPPV, a deep head-hanging maneuver moves the head through a sequence that clears the canal without needing to know the affected side¹. For multi-canal BPPV, we combine the matching maneuvers over one or more sessions. Infrared video goggles show which canals remain after each step, so treatment stops when the eyes are quiet.

Where can I get complex BPPV treatment if urgent care did not help?

Many patients reach our Cumming and Alpharetta clinics after an Epley at urgent care or another clinic did not work. Patients come from Johns Creek, Roswell, Suwanee and across North Atlanta for 60-minute, one-on-one visits, with urgent appointments within 48 hours.

Where can I get help in Alpharetta, Cumming and nearby?

Dr. Manan Patel, PT, DPT, TPS and our team of physical therapists see patients from Alpharetta, Johns Creek, Milton, Roswell, Cumming, Suwanee, Sugar Hill, Buford, Duluth and Forsyth County at two North Atlanta clinics. Every visit is 60 minutes, one-on-one, and urgent appointments are available within 48 hours. We are in-network with Traditional Medicare, BCBS / Anthem and Tricare, and offer a $129 rate per visit for self-pay and out-of-network plans. Not sure where to start? Take the free symptom self-check, or visit our Alpharetta clinic or Cumming clinic page.

Related care

Related questions

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References

1. Yacovino DA, et al. New therapeutic maneuver for anterior canal benign paroxysmal positional vertigo. Journal of Neurology. 2009.
2. Bhattacharyya N, et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngology–Head and Neck Surgery. 2017.
3. von Brevern M, et al. Benign paroxysmal positional vertigo: Diagnostic criteria. Journal of Vestibular Research. 2015.

Answered by Dr. Manan Patel, PT, DPT, TPSDoctor of Physical Therapy, Certified Vestibular Specialist and one of the few certified Therapeutic Pain Specialists in North Atlanta, with 15+ years of outpatient care. About Dr. Patel

This answer is general education, not a diagnosis or a substitute for an examination. If you have new or worsening symptoms, contact your doctor. Call 911 for sudden severe dizziness with trouble speaking, weakness, numbness, double vision or a severe headache.