Objective To compare the effectiveness and complications of our adaptation of the canalith repositioning procedure (CRP) with the expectation treatment for benign paroxysmal positional vertigo.

Study Design A randomized, controlled trial in the setting of a neurotological clinic in Thailand.

Methods Fifty-eight patients with posterior benign paroxysmal positional vertigo were randomly assigned to treatment and control groups using a block of four. The treatment group was treated with the modified CRP technique until the nystagmus disappeared. A mastoid oscillator was not used, nor were any instructions given for patients after the maneuver. Both groups recorded the daily grading of symptoms and the amount of anti-vertiginous drugs (cinnarizine) taken. Objective and subjective assessments were made weekly until the nystagmus disappeared or until 4 weeks had passed since treatment began.

Results The rates of effectiveness of CRP treatment and the control treatment for benign paroxysmal positional vertigo were 75.9% and 48.2%, respectively. There was a significant difference in the treatment outcomes of the CRP and control groups (P = .03). The CRP group used significantly fewer drugs than the control group (P = .001). Complications in the CRP group, such as lateral canalithiasis and fainting, were observed in 13.8% of the patients.

Conclusions The CRP was more effective than the expectation treatment for benign paroxysmal positional vertigo insofar as it provided faster recovery and required less dependence on medication. Complications of CRP were limited to 13.8% of patients.