Each inner ear has three semi-circular canals – the posterior, the anterior and the horizontal canal. The shared entry point of the posterior and anterior canal as they go back to the membrane where the ear crystals that cause BPPV (Benign Paroxysmal Positional Vertigo) normally live is called the “common crus.”

In a case of BPPV, a person can have a misplaced crystal(s) floating in any of one or combination of their 6 inner ear canals. Those crystals are supposed to be in the inner ear, but when a person has BPPV, the crystals have moved and gone floating in one of the canals. This can happen through hormone changes, head trauma or normal aging (amongst other causes).

In my experience, most people [likely] have more than one crystal floating loose, possibly even a sediment of thousands of ear crystals.

Sometimes people even have BPPV in both ears. Anyone with a head injury is most likely going to have it in both ears because each ear probably had ear crystal(s) break loose from the trauma and go floating away from where it belongs into a semi-circular canal.

If people have a lot of crystal sediment in their canal and they improperly treat themselves with the Epley maneuver, the crystal(s) end up converting into the other canal because they don’t pass through the common crus.

Then the person ends up with ear crystals in two canals! [A so-called “canal conversion.”]

And that’s much more difficult to treat.

I see this result in people that try to treat themselves and from clinicians that are not well trained.

This is what we call “multi-canal BPPV” and those are the people I usually need to see more than once. They may need 2-3 visits with me as opposed to one visit if they hadn’t tried to treat themselves.

The reason the self-Epley does work for a lot for people is because the inner ear canals are not totally set horizontal in relation to gravity. The posterior canal is a little lower in the head than the others, making it the most common place the crystals end up.

But if people don’t do the treatment right, or they have a sediment of ear crystals, then they can convert it to anterior canal, through the common crus, which is much more difficult to treat.

In my practice, I see a lot of patients who have converted into multi-canal or anterior canal BPPV, and I get excellent results with these patients as well.

Learn more about my thoughts on this topic below in this video, or head over to our Vertigo & BPPV resource portal.

This blog is provided for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.