Clinical inquiries. What is the best approach to benign paroxysmal positional vertigo in the elderly?

A canalith repositioning maneuver (CRM), such as the Epley or Semont maneuver, should be the first-line treatment for benign paroxysmal positional vertigo (BPPV) in the elderly. Following the Epley maneuver with self-treatment at home using a modified Epley procedure improves outcomes. Postural restrictions are not necessary after CRM treatment. Medications do not work as well as a CRM, but studies comparing treatments are limited.