Canalith Repositioning Maneuvers with Vestibular Rehabilitation for Bilateral Posterior Canal BPPV Secondary to Otitis Media in an Older Adult: A Case Report

Abstract Benign Paroxysmal Positional Vertigo (BPPV) is the most common peripheral vestibular disorder and is especially prevalent among older adults. While most cases are idiopathic, secondary BPPV following otitis media has gained increasing recognition. This case report describes a 63-year-old female with bilateral posterior canal BPPV involving mixed mechanisms(Right-sided cupulolithiasis and left-sided canalithiasis) occurring one year after medically treated otitis media. The diagnosis was established using positional testing and videonystagmography (VNG). The patient underwent a structured seven-week intervention comprising repeated canalith repositioning maneuvers (Epley and Sémont) combined with vestibular rehabilitation including VOR training and Brandt–Daroff habituation exercises. The left-sided BPPV resolved by the third session, while the right-sided cupulolithiasis gradually improved and fully resolved by the seventh session. The Dizziness Handicap Inventory (DHI) score improved from 66/100 to 10/100, and telehealth follow-up after one month confirmed sustained remission. This case highlights the effectiveness of a multimodal approach in managing complex BPPV presentations and underscores the importance of individualized treatment strategies, particularly in older adults with secondary etiologies.