Conclusion:
This case and our simulations emphasize that maneuvers that are designed
to induce the movement of displaced otoconia in one specific canal can
trigger or treat BPPV in other canals. Our study also raises the
question of whether the diagnosis and treatment of BPPV could be
improved if clinicians perform the SRT first and then if no nystagmus is
elicited, perform the Dix-Hallpike maneuver. Finally, we recommend that
clinicians place the head in the correct position for all diagnostic and
therapeutic maneuvers, carefully observe and report the direction of the
nystagmus, and always consider the location of otoconia within the
canals and the possibility of other canals being involved when rendering
a canal-specific diagnosis and treatment for BPPV.