BPPV and post-maneuver restrictions

Timothy C. Hain, MD •Bart Tulicki, DPT. Page last modified: March 7, 2021

Given that the core assumption of BPPV treatment is correct, debris is moved back into the insensitive part of the ear, one would suppose that "what goes up can also go down", and that it might also just move right back where it came from. This is the reason that in the original work on BPPV treatment, there were "post-maneuver restrictions" given, usually involving instructions to avoid positions thought to be likely to allow loose debris to go back into the posterior canal. This mainly boils down to sleeping partially upright.

Although this makes perfect sense, a very large number of studies have suggested that this is not needed.


The use of different post maneuver precautions has been researched for several years now.

At Chicago Dizziness and Hearing, we have treated more than 4000 patients with BPPV. In other words, we have in a single practice, more experience than any of these analyses above, even including meta-analyses. We do continue to advise some restrictions. This is based on wanting to "stick to what works". We do not think that these restrictions are "impractical", and we also think that if we can avoid one or two extra recurrences per 100 patients, it is worth doing.

We continue to recommend after maneuvers that patients sleep with their head elevated (45 deg angle -- i.e. 2 pillows) and to avoid the sleeping with the affected side down for 12-24 hours post treatment. We would suggest avoiding supine exercises (such as Pilates or Yoga) for a week, and also (if practical) defer going to the beauty parlor, or for massages where there is prolonged supine or prone positioning for a week. Other activities we think best avoided would be teeth cleaning by the dental hygeinist, or other dental procedures as these often involve being positioned with the head backwards, vibration, and head turning.