This treatment modification for posterior canal BPPV was developed in August 2006 by Dr. Teixido in the 3D visualization laboratory at the Delaware Biotechnology Institute. This exercise is appropriate for any BPPV patient, even if the side of disease is not known. The posterior canal exercise moves otoconia 60° farther around the circumference of the posterior semicircular duct with each repetition than conventional Brandt-Daroff exercises. The extra motion toward the posterior canal ampulla may enhance contact of the otoconia with dark cells at the base of the ampulla. Dark cells may play an important role in otoconia resorption. The exercise has 6 head positions, but is easy to teach.

1. The patient lies on the right side with the nose pointed 45° upward (head turned toward the left). Wait 20 seconds.
2. The patient sits upright, keeping the head turned to the left. Wait 20 seconds.
3. The patient lies on the left side with the nose pointed 45° downward (head remains turned toward the left). Wait 20 seconds.
4. The patient remains on the left side, but turns the nose to 45° above the horizontal (head now turned toward the right). Wait 20 seconds.
5. The patient sits upright, keeping the head turned to the right. Wait 20 seconds.
6. The patient lies on the right side with the nose pointed 45° downward (head remains turned toward the right). Wait 20 seconds.
   Repeat steps 1 through 6 four more times.

Each repetition (steps 1-6) takes 2 minutes. Five repetitions, three times a day will usually eliminate symptoms faster than conventional Brandt-Daroff exercises.  A single-blinded study comparing time to complete symptom resolution using the posterior canal exercises or Brandt-Daroff exercises is currently in progress.