Can BPPV involve more than one canal?

common condition treated by Vestibular Physical Therapists and involves Canalith Repositioning Manuevers and in some instances, Vestibular Rehabilitation.

Could I have multiple canal BPPV?

Even though it is more common to have single canal BPPV, research has shown that multiple canals are involved in some patients. The prevalence varies from 5% (Moon et al 2006) to even as high as 20% (Si et al 2020) of patients in various publications. In fact, Si et al concludes that multiple canal BPPV is not uncommon in patients in clinical practice.

The following clinical criteria may put you at higher risk of multiple canal BPPV:

  • Older people above the age of 60

  • If you have atherosclerotic risk factors (i.e., hypertension, hyper-lipidemia, diabetes mellitus)

  • If you have osteoporosis

What does this mean to me?

In majority of patients, the canal most often affected in BPPV is the posterior semicircular canal (60-90%). This is followed by the lateral semicircular canal (5-30%) and then anterior semicircular canal (more rare). Therefore, a clinical diagnosis followed by the proper canalith repositioning procedure should give you significant relief and improved function in 1-3 sessions.

However, in other cases, it is not always a home run. Considering you have two inner ears and 3 semicircular canals on each side, there are many potential combinations that are involved in multiple canal BPPV.

For instance, the most common multiple canal combination is ipsilateral posterior and lateral semicircular canal. Or, you could have anterior and lateral semicircular canal. But, this needs to be formally diagnosed by examining your nystagmus and symptoms in order to provide the proper manual reduction treatment.

Oh, and another kicker —- this article doesn’t even delve into patients with mixed canalolithiasis and cupulolithiasis!

If you do have BPPV, I recommend seeking out a Vestibular Specialist that has the time and training to evaluate your medical history and physical examination to make a proper diagnosis and treatment plan. Complex multiple canal cases usually have multiple positional characteristics.

Canalolithiasis and cupulolithiasis may co-exist simultaneously in patients with multiple canal BPPV —- just another reason to seek out professional consultation.

If you are suffering from BPPV, feel free to contact us or book an appointment so we can help you get back to living life to the fullest!