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Otolith Repositioning Exercises

By M. Gideon Hoyle ; Updated August 14, 2017

Otoliths, also called canaliths, are tiny crystals that sit inside a specific portion of your inner ear and help orient your body to the effects of motion and gravity. When these crystals move from their normal location, you can develop a form of dizziness called benign paroxysmal positional vertigo, or BPPV. You can return abnormally placed otoliths to their proper position with the help of specialized exercises.


Your inner ear contains two structures, called the utricle and saccule, which contain otholithic crystals. The actions of these crystals allow you to orient your head to up-and-down movements, back-and-forth movements and right-and-left movements. BPPV occurs when otoliths in your utricle spill into sensitive structures in your inner ear called the semicircular canals. Potential underlying causes for this include infection, physical trauma and advancing age. You are particularly susceptible to otolith displacement when you’re lying down.

Supervised Exercises

The two most common types of repositioning exercises, called the Epley maneuver and the Semont-Liberatory maneuver, can be safely performed only in a doctor’s office or other supervised medical setting. Your doctor will base his choice of these two procedures on the precise location of your displaced otoliths.

During otolith repositioning, a trained physician will guide you through specific head, neck and torso movements designed to shift otoliths in your semicircular canals back into your utricle. After they return to your utricle, these crystals sometimes fall back into your canals, and they may also break up, gather in another harmless location or dissolve altogether.

Brandt-Daroff Exercises

You can perform another group of repositioning exercises, called Brandt-Daroff exercises, on your own after you receive instruction from a health care professional trained in the exercises. During a Brandt-Daroff procedure, you sit upright on the edge of a bed and alternately lower yourself onto your left and right sides for roughly 30 seconds at a time. Typically, you will perform this exercise several times a day over 48 hours after a bout of BPPV symptoms comes to an end.


If you attempt to perform an otolith repositioning exercise without your doctor’s help, you can shift your otoliths to an equally harmful location inside your ear or develop injuries in your back or neck. If you have certain conditions — including a detached retina, esophageal reflux or insufficient blood supply to your spine — you may not be a good candidate for any repositioning procedure.

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