​How to treat:

1:  Begin with the patient positioned sitting at the edge of the table.



2:  Have the patient rotate their head 45 degrees towards the affected ear

3:  Support the patient's head, and quickly move the patient into side-lying with their head facing the table.  The movement should be done quickly and abruptly.  It is helpful to use two hands on the patient's head, supporting the front of their head with the webbed space of your hand.  Patient remains in this position for 30 seconds. 

4:  Hold the patient's head, keeping it in the same position (facing the table).  Quickly, move the patient into the opposite side-lying position.  Abruptly stop the patient's movement when their head nears the table.  The patient's head should be facing away from the table (Brantberg & Bergenius, 2002; Herdman S.J., 2007)





Following liberatory maneuver, re-assess for remaining debris with hallpike test.  Often times, conversion from cupulolithiasis to canalolithiasis occurs, and technique should be followed by a treatment for canalolithiasis.  



Evidence

Anterior canal involvement is rare, and cupuloliathiasis of this canal even less common.  Because of this, the evidence for this technique isn't fully established.     



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