Feasibility and Preliminary Outcomes of a Wearable Inertial Measurement Unit-Guided Canalith Repositioning Procedure for Idiopathic Benign Paroxysmal Positional Vertigo

Objectives.: Self-administered canalith repositioning procedure (CRP) for benign paroxysmal positional vertigo (BPPV) is often limited by inaccurate head positioning. We evaluated the feasibility of an inertial measurement unit (IMU)-guided CRP system relative to specialist-performed CRP and explored head motion parameters associated with outcomes. Methods.: In this prospective comparative study (December 2019-June 2021), 88 patients with BPPV (74 women [84%]; mean [SD] age, 56.5 [15.7] years) underwent IMU-guided CRP with real-time audio feedback (IMU-CRP, n=44) or conventional CRP by a vestibular specialist (DOC-CRP, n=44), matched for BPPV subtype, age, and sex. The primary outcome was 24-hour treatment success, defined as resolution of positional vertigo and absence of nystagmus. Head motion parameters-rotation accuracy, holding duration, and to-and-fro error-were analyzed at one hour in the IMU-CRP group. Results.: Treatment success at 24 hours did not differ significantly between groups (Epley: 61.1% vs. 66.7%; barbecue roll: 50.0% vs. 62.5%; all P>0.05). In an exploratory 90% CI analysis (25-percentage-point margin), the lower bound did not cross the margin for the Epley and combined cohorts, but crossed it for barbecue roll. Among 34 initially resolved IMU-CRP participants, 8 (23.5%) had early recurrence by 24 hours. Longer Epley step 3 holding duration was associated with success (39.2 vs. 31.1 s; P=0.043). Conclusion.: IMU-guided CRP demonstrated technical feasibility, with CRP-naive participants achieving clinically acceptable maneuver accuracy using audio guidance alone. Treatment success did not significantly differ from specialistperformed CRP, but findings remain hypothesis-generating because the noninferiority margin was not pre-specified. HC-BPPV findings are preliminary and require further validation. Early recurrence highlights the need for post-maneuver guidance, and these findings support a future randomized non-inferiority trial.