Ian Purcell MD PhD Otoneurology Call 858 223 2172

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Nystagmus insights · Epley Omniax · Ian Purcell MD PhD

Canalithiasis & Cupulolithiasis Charts

Four positional matrices that map observed nystagmus across yaw and pitch to the involved canal—and to the matching Epley Omniax repositioning protocol.

View the four charts Epley Omniax Chair

Clinician reference — not a home protocol

These matrices are educational clinic references. Zoom the full charts for cell-level detail. Treatment codes assume Epley Omniax (or equivalent multi-axis) positioning with continuous nystagmus monitoring. Do not apply a chair protocol from a screenshot alone without confirming the full pattern across positions.

Workflow

How to use the matrices

Each chart is a lookup: position × suspected canal → expected nystagmus. Match the observed pattern to a column, then follow that column to treatment.

  1. 01

    Pick mechanism & start pose

    Choose canalithiasis vs cupulolithiasis, then head-neutral vs head-down starting orientation—the four charts cover those combinations.

  2. 02

    Drive the coordinate sequence

    Rows list yaw/pitch (Y, P), clinical labels (Dix AD / Dix AS / Sitting / SUP), and system orientation perpendicular to gravity.

  3. 03

    Match the nystagmus column

    Compare latency, direction, torsion, intensity (+/++/+++), and nulls across positions until one canal (or combination) column fits.

  4. 04

    Execute the column’s treatment

    Canalithiasis columns end in a rotation/barrel-roll code. Cupulolithiasis adds an inverted-null hold with occipital vibration before the rotational component.

Chart language

Notation used on every matrix

Same abbreviations appear across nystagmus insights and the Epley Omniax charts.

SymbolMeaningSymbolMeaning
YYawP / PrPitch / pitch rotation component
UFUtricular fugal (excitatory canalith response)UPUtricular pedal (inhibitory / opposite-sense response)
+ / −Excitatory / inhibitory intensity (more signs = stronger)cw / ccwClockwise / counterclockwise torsion
↑ / ↓Upbeat / downbeat vertical componentRB / LBRight-beat / left-beat horizontal nystagmus
NullNo expected nystagmus for that canal in that poseBrBarrel roll
Dix ADDix-Hallpike, right ear downDix ASDix-Hallpike, left ear down
SUPSupine (center / right / left)X2 / X3Repeat rotational cycle 2× or 3× as charted
Interactive diagnostic matrices · Epley Omniax

The four characterization matrices

Extrapolated directly from Dr. Ian Purcell’s clinical charts. Use the tabs below to switch starting postures and mechanisms. Filter by canal group or search coordinates and nystagmus vectors in real time.

Canals

Canalithiasis · Head Neutral Starting Position

Free-floating otoconia dynamics starting from upright head-neutral. Look up yaw/pitch coordinates to match observed nystagmus to canal & treatment.

Coords (Y, P) Position Grav ⊥ Right Posterior RP (Posterior) Left Posterior LP (Posterior) Right Anterior RA (Superior) Left Anterior LA (Superior) Right & Left Posterior Bilateral Posterior Right & Left Anterior Bilateral Anterior Right Post & Right Ant Ipsilateral Vertical R Left Post & Left Ant Ipsilateral Vertical L Right Post & Left Ant RALP Plane Right Ant & Left Post LARP Plane Right Lateral RL (Horizontal) Left Lateral LL (Horizontal) Right & Left Lateral Bilateral Lateral
Baseline
(Y0, P0) Neutral 30° Null Null Null Null Null Null Null Null Null Null Null Null Null
Dix-Hallpike Right (AD)
(Y45, P0) Dix AD 30° Null Null Null Null Null Null Null Null Null Null Null Null Null
(Y45, P30) Dix AD 0° Null Null Null Null Null Null Null Null Null Null Null Null Null
(Y45, P-60) Dix AD 90° UF+++ ccw↑ Null Null Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
 Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
 Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
 Null UP+ RB UF- RB RB
(Y45, P-90) Dix AD 120° UF++++ ccw↑ UF+ cw↑ UF+ ccw↓ UF+ cw↓
UF++++ ccw↑UF+ cw↑
Net: UF+++ ccw↑
UF+ ccw↓UF+ cw↓
Net: UF+ ↓
UF++++ ccw↑UF+ ccw↓
Net: UF+++ ccw
UF+ cw↑UF+ cw↓
Net: UF+ cw
UF++++ ccw↑UF+ cw↓
Net: UF+++ ccw↑
UF+ ccw↓UF+ cw↑
Net: Null
 UP+ RB UF- RB RB
(Y45, P-120) Dix AD 150° UF+++++ ccw↑ UF++ cw↑ UF++ ccw↓ UF++ cw↓
UF+++++ ccw↑UF++ cw↑
Net: UF+++ ccw↑
UF++ ccw↓UF++ cw↓
Net: UF++ ↓
UF+++++ ccw↑UF++ ccw↓
Net: UF+++ ccw
UF++ cw↑UF++ cw↓
Net: UF++ cw
UF+++++ ccw↑UF++ cw↓
Net: UF+++ ccw↑
UF++ ccw↓UF++ cw↑
Net: Null
 UP+ RB UF- RB RB
(Y45, P-135) Dix AD 165° UF+++++ ccw↑ UF++ cw↑ UF++ ccw↓ UF++ cw↓
UF+++++ ccw↑UF++ cw↑
Net: UF+++ ccw↑
UF++ ccw↓UF++ cw↓
Net: UF++ ↓
UF+++++ ccw↑UF++ ccw↓
Net: UF+++ ccw
UF++ cw↑UF++ cw↓
Net: UF++ cw
UF+++++ ccw↑UF++ cw↓
Net: UF+++ ccw↑
UF++ ccw↓UF++ cw↑
Net: Null
 UP+ RB UF- RB RB
(Y45, P-150) Dix AD 180° UF++++++ ccw↑ UF+++ cw↑ UF+++ ccw↓ UF+++ cw↓
UF++++++ ccw↑UF+++ cw↑
Net: UF+++ ccw↑
UF+++ ccw↓UF+++ cw↓
Net: UF+++ ↓
UF++++++ ccw↑UF+++ ccw↓
Net: UF+++ ccw
UF+++ cw↑UF+++ cw↓
Net: UF+++ cw
UF++++++ ccw↑UF+++ cw↓
Net: UF+++ ccw↑
UF+++ ccw↓UF+++ cw↑
Net: Null
 UP+ RB UF- RB RB
Sitting (AD Recovery)
(Y45, P0) Sitting 30° UP---(---) cw↓ UP-(--) ccw↓ UP-(--) cw↑ UP-(--) ccw↑
UP---(---) cw↓UP-(--) ccw↓
Net: UP-(--) cw↓
UP-(--) cw↑UP-(--) ccw↑
Net: UP-(--) ↑
UP---(---) cw↓UP-(--) cw↑
Net: UP-(--) cw↓
UP-(--) ccw↓UP-(--) ccw↑
Net: UP-(--) ccw
UP---(---) cw↓UP-(--) ccw↑
Net: UP-(--) cw↓
UP-(--) cw↑UP-(--) ccw↓
Net: Null
 UF- LB UP+ LB LB
(Y0, P0) Sitting 30° Null Null Null Null Null Null Null Null Null Null Null Null Null
Baseline
(Y0, P0) Neutral 30° Null Null Null Null Null Null Null Null Null Null Null Null Null
Dix-Hallpike Left (AS)
(Y-45, P0) Dix AS 30° Null Null Null Null Null Null Null Null Null Null Null Null Null
(Y-45, P30) Dix AS 0° Null Null Null Null Null Null Null Null Null Null Null Null Null
(Y-45, P-60) Dix AS 90° Null UF+++ cw↑ Null Null
NullUF+++ cw↑
Net: UF+++ cw↑
 Null Null
UF+++ cw↑Null
Net: UF+++ cw↑
 Null
NullUF+++ cw↑
Net: UF+++ cw↑
 UF- LB UP+ LB LB
(Y-45, P-90) Dix AS 120° UF+ ccw↑ UF++++ cw↑ UF+ ccw↓ UF+ cw↓
UF+ ccw↑UF++++ cw↑
Net: UF+++ cw↑
UF+ ccw↓UF+ cw↓
Net: UF+ ↓
UF+ ccw↑UF+ ccw↓
Net: UF+ ccw
UF++++ cw↑UF+ cw↓
Net: UF+++ cw
UF+ ccw↑UF+ cw↓
Net: Null
UF+ ccw↓UF++++ cw↑
Net: UF+++ cw↑
 UF- LB UP+ LB LB
(Y-45, P-120) Dix AS 150° UF++ ccw↑ UF+++++ cw↑ UF++ ccw↓ UF++ cw↓
UF++ ccw↑UF+++++ cw↑
Net: UF+++ cw↑
UF++ ccw↓UF++ cw↓
Net: UF++ ↓
UF++ ccw↑UF++ ccw↓
Net: UF++ ccw
UF+++++ cw↑UF++ cw↓
Net: UF+++ cw
UF++ ccw↑UF++ cw↓
Net: Null
UF++ ccw↓UF+++++ cw↑
Net: UF+++ cw↑
 UF- LB UP+ LB LB
(Y-45, P-135) Dix AS 165° UF++ ccw↑ UF+++++ cw↑ UF++ ccw↓ UF++ cw↓
UF++ ccw↑UF+++++ cw↑
Net: UF+++ cw↑
UF++ ccw↓UF++ cw↓
Net: UF++ ↓
UF++ ccw↑UF++ ccw↓
Net: UF++ ccw
UF+++++ cw↑UF++ cw↓
Net: UF+++ cw
UF++ ccw↑UF++ cw↓
Net: Null
UF++ ccw↓UF+++++ cw↑
Net: UF+++ cw↑
 UF- LB UP+ LB LB
(Y-45, P-150) Dix AS 180° UF+++ ccw↑ UF++++++ cw↑ UF+++ ccw↓ UF+++ cw↓
UF+++ ccw↑UF++++++ cw↑
Net: UF+++ cw↑
UF+++ ccw↓UF+++ cw↓
Net: UF+++ ↓
UF+++ ccw↑UF+++ ccw↓
Net: UF+++ ccw
UF++++++ cw↑UF+++ cw↓
Net: UF+++ cw
UF+++ ccw↑UF+++ cw↓
Net: Null
UF+++ ccw↓UF++++++ cw↑
Net: UF+++ cw↑
 UF- LB UP+ LB LB
Sitting (AS Recovery)
(Y-45, P0) Sitting 30° UP-(--) cw↓ UP---(---) ccw↓ UP-(--) cw↑ UP-(--) ccw↑
UP-(--) cw↓UP---(---) ccw↓
Net: UP--- ↓
UP-(--) cw↑UP-(--) ccw↑
Net: UP-(--) ↑
UP-(--) cw↓UP-(--) cw↑
Net: UP-(--) cw
UP---(---) ccw↓UP-(--) ccw↑
Net: UP-(--) ccw↓
UP-(--) cw↓UP-(--) ccw↑
Net: Null
UP-(--) cw↑UP---(---) ccw↓
Net: UP-(--) ccw↓
 UP+ RB UF- RB RB
(Y0, P0) Sitting 30° Null Null Null Null Null Null Null Null Null Null Null Null Null
Baseline
(Y0, P0) Neutral 30° Null Null Null Null Null Null Null Null Null Null Null Null Null
Supine Roll (P-60)
(Y0, P-60) SUP Center 90° UF++ ccw↑ UF++ cw↑ Null Null
UF++ ccw↑UF++ cw↑
Net: UF++ ↑
 Null
UF++ ccw↑Null
Net: UF++ ccw↑
UF++ cw↑Null
Net: UF++ cw↑
UF++ ccw↑Null
Net: UF++ ccw↑
NullUF++ cw↑
Net: UF++ cw↑
 Null Null Null
(Y45, P-60) SUP Right 90° UF+++ ccw↑ Null Null Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
 Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
 Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
 Null UP+ RB UF- RB RB
(Y60, P-60) SUP Right 90° UF+++ ccw↑ Null UF+ ccw↓ Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
UF+ ccw↓Null
Net: UF+ ccw↓
UF+++ ccw↑UF+ ccw↓
Net: UF++ ccw↑
 Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
UF+ ccw↓Null
Net: UF+ ccw↓
 UP+++ RB UF--- RB RB
(Y-45, P-60) SUP Left 90° Null UF+++ cw↑ Null Null
NullUF+++ cw↑
Net: UF+++ cw↑
 Null Null
UF+++ cw↑Null
Net: UF+++ cw↑
 Null
NullUF+++ cw↑
Net: UF+++ cw↑
 UF- LB UP+ LB LB
(Y-60, P-60) SUP Left 90° Null UF+++ cw↑ Null UF+ cw↓
NullUF+++ cw↑
Net: UF+++ cw↑
NullUF+ cw↓
Net: UF+ cw↓
 Null
UF+++ cw↑UF+ cw↓
Net: UF++ cw↑
NullUF+ cw↓
Net: UF+ cw↓
NullUF+++ cw↑
Net: UF+++ cw↑
 UF--- LB UP+++ LB LB
Supine Roll (P-75)
(Y0, P-75) SUP Center 105° UF++ ccw↑ UF++ cw↑ Null Null
UF++ ccw↑UF++ cw↑
Net: UF++ ↑
 Null
UF++ ccw↑Null
Net: UF++ ccw↑
UF++ cw↑Null
Net: UF++ cw↑
UF++ ccw↑Null
Net: UF++ ccw↑
NullUF++ cw↑
Net: UF++ cw↑
 Null Null Null
(Y45, P-75) SUP Right 105° UF+++ ccw↑ Null Null Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
 Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
 Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
 Null UP+ RB UF- RB RB
(Y60, P-75) SUP Right 105° UF+++ ccw↑ Null UF+ ccw↓ Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
UF+ ccw↓Null
Net: UF+ ccw↓
UF+++ ccw↑UF+ ccw↓
Net: UF++ ccw↑
 Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
UF+ ccw↓Null
Net: UF+ ccw↓
 UP+++ RB UF--- RB RB
(Y-45, P-75) SUP Left 105° Null UF+++ cw↑ Null Null
NullUF+++ cw↑
Net: UF+++ cw↑
 Null Null
UF+++ cw↑Null
Net: UF+++ cw↑
 Null
NullUF+++ cw↑
Net: UF+++ cw↑
 UF- LB UP+ LB LB
(Y-60, P-75) SUP Left 105° Null UF+++ cw↑ Null UF+ cw↓
NullUF+++ cw↑
Net: UF+++ cw↑
NullUF+ cw↓
Net: UF+ cw↓
 Null
UF+++ cw↑UF+ cw↓
Net: UF++ cw↑
NullUF+ cw↓
Net: UF+ cw↓
NullUF+++ cw↑
Net: UF+++ cw↑
 UF--- LB UP+++ LB LB
Supine Roll (P-90)
(Y0, P-90) SUP Center 120° UF+++ ccw↑ UF+++ cw↑ UF+ ccw↓ UF+ cw↓
UF+++ ccw↑UF+++ cw↑
Net: UF+++ ↑
UF+ ccw↓UF+ cw↓
Net: UF+ ↓
UF+++ ccw↑UF+ ccw↓
Net: UF++ ccw↑
UF+++ cw↑UF+ cw↓
Net: UF++ cw↑
UF+++ ccw↑UF+ cw↓
Net: UF++ ccw↑
UF+ ccw↓UF+++ cw↑
Net: UF++ cw↑
 Null Null Null
(Y45, P-90) SUP Right 120° UF+++ ccw↑ Null Null Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
 Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
 Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
 Null UP+ RB UF- RB RB
(Y60, P-90) SUP Right 120° UF+++ ccw↑ Null UF+ ccw↓ Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
UF+ ccw↓Null
Net: UF+ ccw↓
UF+++ ccw↑UF+ ccw↓
Net: UF++ ccw↑
 Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
UF+ ccw↓Null
Net: UF+ ccw↓
 UP+++ RB UF--- RB RB
(Y-45, P-90) SUP Left 120° Null UF+++ cw↑ Null Null
NullUF+++ cw↑
Net: UF+++ cw↑
 Null Null
UF+++ cw↑Null
Net: UF+++ cw↑
 Null
NullUF+++ cw↑
Net: UF+++ cw↑
 UF- LB UP+ LB LB
(Y-60, P-90) SUP Left 120° Null UF+++ cw↑ Null UF+ cw↓
NullUF+++ cw↑
Net: UF+++ cw↑
NullUF+ cw↓
Net: UF+ cw↓
 Null
UF+++ cw↑UF+ cw↓
Net: UF++ cw↑
NullUF+ cw↓
Net: UF+ cw↓
NullUF+++ cw↑
Net: UF+++ cw↑
 UF--- LB UP+++ LB LB
Epley Omniax Repositioning Computer-Assisted Rotation Protocol Yaw (Y), pitch (Pr/P), and 360° rotational barrel roll
Y45, Pr-360X3 Right Posterior Y-45, Pr-360X3 Left Posterior Y-45, Pr+360X3 Right Anterior Y+45, Pr+360X3 Left Anterior Y+45, Pr-360X3; Y-45, Pr-360X3 Yaw chosen by most robust canal Y-45, Pr+360X3; Y+45, Pr+360X3 Yaw chosen by most robust canal Y+45, Pr-360X3; Y-45, Pr+360X3 Yaw chosen by most robust canal Y-45, Pr-360X3; Y+45, Pr+360X3 Yaw chosen by most robust canal Y+45: (P+110 & Pr-360)X3 Combination Protocol Y-45: (P+110 & Pr-360)X3 Combination Protocol Y0, P-75, Br to Left x 3 Right Lateral 360° Barrel Roll Y0, P-75, Br to Right x 3 Left Lateral 360° Barrel Roll — Sequential roll to less affected ear

Canalithiasis · Head Down (30°) Starting Position

Free-floating otoconia dynamics starting from 30° head-down tilt on the Epley Omniax Chair.

Coords (Y, P) Position Grav ⊥ Right Posterior RP (Posterior) Left Posterior LP (Posterior) Right Anterior RA (Superior) Left Anterior LA (Superior) Right & Left Posterior Bilateral Posterior Right & Left Anterior Bilateral Anterior Right Post & Right Ant Ipsilateral Vertical R Left Post & Left Ant Ipsilateral Vertical L Right Post & Left Ant RALP Plane Right Ant & Left Post LARP Plane Right Lateral RL (Horizontal) Left Lateral LL (Horizontal) Right & Left Lateral Bilateral Lateral
Baseline
(Y0, P0) Neutral 0° Null Null Null Null Null Null Null Null Null Null Null Null Null
Dix-Hallpike Right (AD)
(Y45, P0) Dix AD 0° Null Null Null Null Null Null Null Null Null Null Null Null Null
(Y45, P-60) Dix AD 60° UF++ ccw↑ Null Null Null
UF++ ccw↑Null
Net: UF++ ccw↑
 Null
UF++ ccw↑Null
Net: UF++ ccw↑
 Null
UF++ ccw↑Null
Net: UF++ ccw↑
 Null UP+ RB UF- RB RB
(Y45, P-90) Dix AD 90° UF+++ ccw↑ Null Null Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
 Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
 Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
 Null UP+ RB UF- RB RB
(Y45, P-120) Dix AD 120° UF++++ ccw↑ UF+ cw↑ UF+ ccw↓ UF+ cw↓
UF++++ ccw↑UF+ cw↑
Net: UF+++ ccw↑
UF+ ccw↓UF+ cw↓
Net: UF+ ↓
UF++++ ccw↑UF+ ccw↓
Net: UF+++ ccw
UF+ cw↑UF+ cw↓
Net: UF+ cw
UF++++ ccw↑UF+ cw↓
Net: UF+++ ccw↑
UF+ ccw↓UF+ cw↑
Net: Null
 UP+ RB UF- RB RB
(Y45, P-135) Dix AD 135° UF++++ ccw↑ UF+ cw↑ UF+ ccw↓ UF+ cw↓
UF++++ ccw↑UF+ cw↑
Net: UF+++ ccw↑
UF+ ccw↓UF+ cw↓
Net: UF+ ↓
UF++++ ccw↑UF+ ccw↓
Net: UF+++ ccw
UF+ cw↑UF+ cw↓
Net: UF+ cw
UF++++ ccw↑UF+ cw↓
Net: UF+++ ccw↑
UF+ ccw↓UF+ cw↑
Net: Null
 UP+ RB UF- RB RB
(Y45, P-150) Dix AD 150° UF+++++ ccw↑ UF++ cw↑ UF++ ccw↓ UF++ cw↓
UF+++++ ccw↑UF++ cw↑
Net: UF+++ ccw↑
UF++ ccw↓UF++ cw↓
Net: UF++ ↓
UF+++++ ccw↑UF++ ccw↓
Net: UF+++ ccw
UF++ cw↑UF++ cw↓
Net: UF++ cw
UF+++++ ccw↑UF++ cw↓
Net: UF+++ ccw↑
UF++ ccw↓UF++ cw↑
Net: Null
 UP+ RB UF- RB RB
Sitting (AD Recovery)
(Y45, P0) Sitting 0° UP--(---) cw↓ UP-- ccw↓ UP-- cw↑ UP-- ccw↑
UP--(---) cw↓UP-- ccw↓
Net: UP--- cw↓
UP-- cw↑UP-- ccw↑
Net: UP-- ↑
UP--(---) cw↓UP-- cw↑
Net: UP--- cw↓
UP-- ccw↓UP-- ccw↑
Net: UP-- ccw
UP--(---) cw↓UP-- ccw↑
Net: UP--- cw↓
UP-- cw↑UP-- ccw↓
Net: Null
 UF- LB UP+ LB LB
(Y0, P0) Sitting 0° Null Null Null Null Null Null Null Null Null Null Null Null Null
Baseline
(Y0, P0) Neutral 0° Null Null Null Null Null Null Null Null Null Null Null Null Null
Dix-Hallpike Left (AS)
(Y-45, P0) Dix AS 0° Null Null Null Null Null Null Null Null Null Null Null Null Null
(Y-45, P-60) Dix AS 60° Null UF++ cw↑ Null Null
NullUF++ cw↑
Net: UF++ cw↑
 Null Null
UF++ cw↑Null
Net: UF++ cw↑
 Null
NullUF++ cw↑
Net: UF++ cw↑
 UF- LB UP+ LB LB
(Y-45, P-90) Dix AS 90° Null UF+++ cw↑ Null Null
NullUF+++ cw↑
Net: UF+++ cw↑
 Null Null
UF+++ cw↑Null
Net: UF+++ cw↑
 Null
NullUF+++ cw↑
Net: UF+++ cw↑
 UF- LB UP+ LB LB
(Y-45, P-120) Dix AS 120° UF+ ccw↑ UF++++ cw↑ UF+ ccw↓ UF+ cw↓
UF+ ccw↑UF++++ cw↑
Net: UF+++ cw↑
UF+ ccw↓UF+ cw↓
Net: UF+ ↓
UF+ ccw↑UF+ ccw↓
Net: UF+ ccw
UF++++ cw↑UF+ cw↓
Net: UF+++ cw
UF+ ccw↑UF+ cw↓
Net: Null
UF+ ccw↓UF++++ cw↑
Net: UF+++ cw↑
 UF- LB UP+ LB LB
(Y-45, P-135) Dix AS 135° UF+ ccw↑ UF++++ cw↑ UF+ ccw↓ UF+ cw↓
UF+ ccw↑UF++++ cw↑
Net: UF+++ cw↑
UF+ ccw↓UF+ cw↓
Net: UF+ ↓
UF+ ccw↑UF+ ccw↓
Net: UF+ ccw
UF++++ cw↑UF+ cw↓
Net: UF+++ cw
UF+ ccw↑UF+ cw↓
Net: Null
UF+ ccw↓UF++++ cw↑
Net: UF+++ cw↑
 UF- LB UP+ LB LB
(Y-45, P-150) Dix AS 150° UF++ ccw↑ UF+++++ cw↑ UF++ ccw↓ UF++ cw↓
UF++ ccw↑UF+++++ cw↑
Net: UF+++ cw↑
UF++ ccw↓UF++ cw↓
Net: UF++ ↓
UF++ ccw↑UF++ ccw↓
Net: UF++ ccw
UF+++++ cw↑UF++ cw↓
Net: UF+++ cw
UF++ ccw↑UF++ cw↓
Net: Null
UF++ ccw↓UF+++++ cw↑
Net: UF+++ cw↑
 UF- LB UP+ LB LB
Sitting (AS Recovery)
(Y-45, P0) Sitting 0° UP-- cw↓ UP--(---) ccw↓ UP-- cw↑ UP-- ccw↑
UP-- cw↓UP--(---) ccw↓
Net: UP--- ccw↓
UP-- cw↑UP-- ccw↑
Net: UP-- ↑
UP-- cw↓UP-- cw↑
Net: UP-- cw
UP--(---) ccw↓UP-- ccw↑
Net: UP--- ccw↓
UP-- cw↓UP-- ccw↑
Net: Null
UP-- cw↑UP--(---) ccw↓
Net: UP--- ccw↓
 UP+ RB UF- RB RB
(Y0, P0) Sitting 0° Null Null Null Null Null Null Null Null Null Null Null Null Null
Baseline
(Y0, P0) Neutral 0° Null Null Null Null Null Null Null Null Null Null Null Null Null
Supine Roll (P-75)
(Y0, P-75) SUP Center 75° UF++ ccw↑ UF++ cw↑ Null Null
UF++ ccw↑UF++ cw↑
Net: UF++ ↑
 Null
UF++ ccw↑Null
Net: UF++ ccw↑
UF++ cw↑Null
Net: UF++ cw↑
UF++ ccw↑Null
Net: UF++ ccw↑
NullUF++ cw↑
Net: UF++ cw↑
 Null Null Null
(Y45, P-75) SUP Right 75° UF+++ ccw↑ Null Null Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
 Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
 Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
 Null UP+ RB UF- RB RB
(Y60, P-75) SUP Right 75° UF+++ ccw↑ Null UF+ ccw↓ Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
UF+ ccw↓Null
Net: UF+ ccw↓
UF+++ ccw↑UF+ ccw↓
Net: UF++ ccw↑
 Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
UF+ ccw↓Null
Net: UF+ ccw↓
 UP+++ RB UF--- RB RB
(Y-45, P-75) SUP Left 75° Null UF+++ cw↑ Null Null
NullUF+++ cw↑
Net: UF+++ cw↑
 Null Null
UF+++ cw↑Null
Net: UF+++ cw↑
 Null
NullUF+++ cw↑
Net: UF+++ cw↑
 UF- LB UP+ LB LB
(Y-60, P-75) SUP Left 75° Null UF+++ cw↑ Null UF+ cw↓
NullUF+++ cw↑
Net: UF+++ cw↑
NullUF+ cw↓
Net: UF+ cw↓
 Null
UF+++ cw↑UF+ cw↓
Net: UF++ cw↑
NullUF+ cw↓
Net: UF+ cw↓
NullUF+++ cw↑
Net: UF+++ cw↑
 UF--- LB UP+++ LB LB
Supine Roll (P-90)
(Y0, P-90) SUP Center 90° UF++ ccw↑ UF++ cw↑ Null Null
UF++ ccw↑UF++ cw↑
Net: UF++ ↑
 Null
UF++ ccw↑Null
Net: UF++ ccw↑
UF++ cw↑Null
Net: UF++ cw↑
UF++ ccw↑Null
Net: UF++ ccw↑
NullUF++ cw↑
Net: UF++ cw↑
 Null Null Null
(Y45, P-90) SUP Right 90° UF+++ ccw↑ Null Null Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
 Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
 Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
 Null UP+ RB UF- RB RB
(Y60, P-90) SUP Right 90° UF+++ ccw↑ Null UF+ ccw↓ Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
UF+ ccw↓Null
Net: UF+ ccw↓
UF+++ ccw↑UF+ ccw↓
Net: UF++ ccw↑
 Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
UF+ ccw↓Null
Net: UF+ ccw↓
 UP+++ RB UF--- RB RB
(Y-45, P-90) SUP Left 90° Null UF+++ cw↑ Null Null
NullUF+++ cw↑
Net: UF+++ cw↑
 Null Null
UF+++ cw↑Null
Net: UF+++ cw↑
 Null
NullUF+++ cw↑
Net: UF+++ cw↑
 UF- LB UP+ LB LB
(Y-60, P-90) SUP Left 90° Null UF+++ cw↑ Null UF+ cw↓
NullUF+++ cw↑
Net: UF+++ cw↑
NullUF+ cw↓
Net: UF+ cw↓
 Null
UF+++ cw↑UF+ cw↓
Net: UF++ cw↑
NullUF+ cw↓
Net: UF+ cw↓
NullUF+++ cw↑
Net: UF+++ cw↑
 UF--- LB UP+++ LB LB
Supine Roll (P-120)
(Y0, P-120) SUP Center 120° UF+++ ccw↑ UF+++ cw↑ UF+ ccw↓ UF+ cw↓
UF+++ ccw↑UF+++ cw↑
Net: UF+++ ↑
UF+ ccw↓UF+ cw↓
Net: UF+ ↓
UF+++ ccw↑UF+ ccw↓
Net: UF++ ccw↑
UF+++ cw↑UF+ cw↓
Net: UF++ cw↑
UF+++ ccw↑UF+ cw↓
Net: UF++ ccw↑
UF+ ccw↓UF+++ cw↑
Net: UF++ cw↑
 Null Null Null
(Y45, P-120) SUP Right 120° UF+++ ccw↑ Null Null Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
 Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
 Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
 Null UP+ RB UF- RB RB
(Y60, P-120) SUP Right 120° UF+++ ccw↑ Null UF+ ccw↓ Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
UF+ ccw↓Null
Net: UF+ ccw↓
UF+++ ccw↑UF+ ccw↓
Net: UF++ ccw↑
 Null
UF+++ ccw↑Null
Net: UF+++ ccw↑
UF+ ccw↓Null
Net: UF+ ccw↓
 UP+++ RB UF--- RB RB
(Y-45, P-120) SUP Left 120° Null UF+++ cw↑ Null Null
NullUF+++ cw↑
Net: UF+++ cw↑
 Null Null
UF+++ cw↑Null
Net: UF+++ cw↑
 Null
NullUF+++ cw↑
Net: UF+++ cw↑
 UF- LB UP+ LB LB
(Y-60, P-120) SUP Left 120° Null UF+++ cw↑ Null UF+ cw↓
NullUF+++ cw↑
Net: UF+++ cw↑
NullUF+ cw↓
Net: UF+ cw↓
 Null
UF+++ cw↑UF+ cw↓
Net: UF++ cw↑
NullUF+ cw↓
Net: UF+ cw↓
NullUF+++ cw↑
Net: UF+++ cw↑
 UF--- LB UP+++ LB LB
Epley Omniax Repositioning Computer-Assisted Rotation Protocol Yaw (Y), pitch (Pr/P), and 360° rotational barrel roll
Y45, Pr-360X3 Right Posterior Y-45, Pr-360X3 Left Posterior Y-45, Pr+360X3 Right Anterior Y+45, Pr+360X3 Left Anterior Y+45, Pr-360X3; Y-45, Pr-360X3 Yaw chosen by most robust canal Y-45, Pr+360X3; Y+45, Pr+360X3 Yaw chosen by most robust canal Y+45, Pr-360X3; Y-45, Pr+360X3 Yaw chosen by most robust canal Y-45, Pr-360X3; Y+45, Pr+360X3 Yaw chosen by most robust canal Y+45: (P+110 & Pr-360)X3 Combination Protocol Y-45: (P+110 & Pr-360)X3 Combination Protocol Y0, P-75, Br to Left x 3 Right Lateral 360° Barrel Roll Y0, P-75, Br to Right x 3 Left Lateral 360° Barrel Roll — Sequential roll to less affected ear

Cupulolithiasis · Head Neutral Starting Position

Heavy cupula (adherent otoliths) dynamics with persistent nystagmus, inverted null coordinates, and liberatory roll protocols.

Coords (Y, P) Position Grav ⊥ Right Posterior RP (Posterior) Left Posterior LP (Posterior) Right Anterior RA (Superior) Left Anterior LA (Superior) Right & Left Posterior Bilateral Posterior Right & Left Anterior Bilateral Anterior Right Post & Right Ant Ipsilateral Vertical R Left Post & Left Ant Ipsilateral Vertical L Right Post & Left Ant RALP Plane Right Ant & Left Post LARP Plane Right Lateral RL (Horizontal) Left Lateral LL (Horizontal) Right & Left Lateral Bilateral Lateral
Baseline
(Y0, P0) Neutral 30° UF+ ccw↑ UF+ cw↑ UP- cw↑ UP- ccw↑
UF+ ccw↑UF+ cw↑
Net: UF+ ↑
UP- cw↑UP- ccw↑
Net: UP- ↑
UF+ ccw↑UP- cw↑
Net: ↑
UF+ cw↑UP- ccw↑
Net: ↑
UF+ ccw↑UP- ccw↑
Net: ccw↑
UP- cw↑UF+ cw↑
Net: cw↑
 UP+ RB UP+ LB Null
Dix-Hallpike Right (AD)
(Y45, P0) Dix AD 30° UF+ ccw↑ UF+ cw↑ UP- cw↑ UP- ccw↑
UF+ ccw↑UF+ cw↑
Net: UF+ ↑
UP- cw↑UP- ccw↑
Net: UP- ↑
UF+ ccw↑UP- cw↑
Net: ↑
UF+ cw↑UP- ccw↑
Net: ↑
UF+ ccw↑UP- ccw↑
Net: ccw↑
UP- cw↑UF+ cw↑
Net: cw↑
 UP+ RB UP+ LB Null
(Y45, P30) Dix AD 0° Null Null Null Null Null Null Null Null Null Null Null Null Null
(Y45, P-60) Dix AD 90° UF+++ ccw↑ Null Null UP--- ccw↑
UF+++ ccw↑Null
Net: UF+++ ccw↑
NullUP--- ccw↑
Net: UP--- ccw↑
UF+++ ccw↑Null
Net: UF+++ ccw↑
NullUP--- ccw↑
Net: UP--- ccw↑
UF+++ ccw↑UP--- ccw↑
Net: ccw↑
 Null UF- LB UP+ LB LB
(Y45, P-90) Dix AD 120° UF++++ ccw↑ Null Null UP---- ccw↑
UF++++ ccw↑Null
Net: UF++++ ccw↑
NullUP---- ccw↑
Net: UP---- ccw↑
UF++++ ccw↑Null
Net: UF++++ ccw↑
NullUP---- ccw↑
Net: UP---- ccw↑
UF++++ ccw↑UP---- ccw↑
Net: ccw↑
 Null UF- LB UP+ LB LB
(Y45, P-120) Dix AD 150° UF+++++ ccw↑ Null Null UP----- ccw↑
UF+++++ ccw↑Null
Net: UF+++++ ccw↑
NullUP----- ccw↑
Net: UP----- ccw↑
UF+++++ ccw↑Null
Net: UF+++++ ccw↑
NullUP----- ccw↑
Net: UP----- ccw↑
UF+++++ ccw↑UP----- ccw↑
Net: ccw↑
 Null UF- LB UP+ LB LB
(Y45, P-135) Dix AD 165° UF+++++ ccw↑ Null Null UP----- ccw↑
UF+++++ ccw↑Null
Net: UF+++++ ccw↑
NullUP----- ccw↑
Net: UP----- ccw↑
UF+++++ ccw↑Null
Net: UF+++++ ccw↑
NullUP----- ccw↑
Net: UP----- ccw↑
UF+++++ ccw↑UP----- ccw↑
Net: ccw↑
 Null UF- LB UP+ LB LB
(Y45, P-150) Dix AD 180° Null Null Null Null Null Null Null Null Null Null Null Null Null
Sitting (AD Recovery)
(Y45, P0) Sitting 30° UF+ ccw↑ UF+ cw↑ UP- cw↑ UP- ccw↑
UF+ ccw↑UF+ cw↑
Net: UF+ ↑
UP- cw↑UP- ccw↑
Net: UP- ↑
UF+ ccw↑UP- cw↑
Net: ↑
UF+ cw↑UP- ccw↑
Net: ↑
UF+ ccw↑UP- ccw↑
Net: ccw↑
UP- cw↑UF+ cw↑
Net: cw↑
 UP+ RB UF- RB RB
(Y0, P0) Sitting 30° UF+ ccw↑ UF+ cw↑ UP- cw↑ UP- ccw↑
UF+ ccw↑UF+ cw↑
Net: UF+ ↑
UP- cw↑UP- ccw↑
Net: UP- ↑
UF+ ccw↑UP- cw↑
Net: ↑
UF+ cw↑UP- ccw↑
Net: ↑
UF+ ccw↑UP- ccw↑
Net: ccw↑
UP- cw↑UF+ cw↑
Net: cw↑
 UP+ RB UP+ LB Null
Baseline
(Y0, P0) Neutral 30° UF+ ccw↑ UF+ cw↑ UP- cw↑ UP- ccw↑
UF+ ccw↑UF+ cw↑
Net: UF+ ↑
UP- cw↑UP- ccw↑
Net: UP- ↑
UF+ ccw↑UP- cw↑
Net: ↑
UF+ cw↑UP- ccw↑
Net: ↑
UF+ ccw↑UP- ccw↑
Net: ccw↑
UP- cw↑UF+ cw↑
Net: cw↑
 UP+ RB UP+ LB Null
Dix-Hallpike Left (AS)
(Y-45, P0) Dix AS 30° UF+ ccw↑ UF+ cw↑ UP- cw↑ UP- ccw↑
UF+ ccw↑UF+ cw↑
Net: UF+ ↑
UP- cw↑UP- ccw↑
Net: UP- ↑
UF+ ccw↑UP- cw↑
Net: ↑
UF+ cw↑UP- ccw↑
Net: ↑
UF+ ccw↑UP- ccw↑
Net: ccw↑
UP- cw↑UF+ cw↑
Net: cw↑
 UP+ RB UP+ LB Null
(Y-45, P30) Dix AS 0° Null Null Null Null Null Null Null Null Null Null Null Null Null
(Y-45, P-60) Dix AS 90° Null UF+++ cw↑ UP--- cw↑ Null
NullUF+++ cw↑
Net: UF+++ cw↑
UP--- cw↑Null
Net: UP--- cw↑
NullUP--- cw↑
Net: UP--- cw↑
UF+++ cw↑Null
Net: UF+++ cw↑
 Null
UP--- cw↑UF+++ cw↑
Net: cw↑
 UP+ RB UF- RB RB
(Y-45, P-90) Dix AS 120° Null UF++++ cw↑ UP---- cw↑ Null
NullUF++++ cw↑
Net: UF++++ cw↑
UP---- cw↑Null
Net: UP---- cw↑
NullUP---- cw↑
Net: UP---- cw↑
UF++++ cw↑Null
Net: UF++++ cw↑
 Null
UP---- cw↑UF++++ cw↑
Net: cw↑
 UP+ RB UF- RB RB
(Y-45, P-120) Dix AS 150° Null UF+++++ cw↑ UP----- cw↑ Null
NullUF+++++ cw↑
Net: UF+++++ cw↑
UP----- cw↑Null
Net: UP----- cw↑
NullUP----- cw↑
Net: UP----- cw↑
UF+++++ cw↑Null
Net: UF+++++ cw↑
 Null
UP----- cw↑UF+++++ cw↑
Net: cw↑
 UP+ RB UF- RB RB
(Y-45, P-135) Dix AS 165° Null UF+++++ cw↑ UP----- cw↑ Null
NullUF+++++ cw↑
Net: UF+++++ cw↑
UP----- cw↑Null
Net: UP----- cw↑
NullUP----- cw↑
Net: UP----- cw↑
UF+++++ cw↑Null
Net: UF+++++ cw↑
 Null
UP----- cw↑UF+++++ cw↑
Net: cw↑
 UP+ RB UF- RB RB
(Y-45, P-150) Dix AS 180° Null Null Null Null Null Null Null Null Null Null Null Null Null
Sitting (AS Recovery)
(Y-45, P0) Sitting 30° UF+ ccw↑ UF+ cw↑ UP- cw↑ UP- ccw↑
UF+ ccw↑UF+ cw↑
Net: UF+ ↑
UP- cw↑UP- ccw↑
Net: UP- ↑
UF+ ccw↑UP- cw↑
Net: ↑
UF+ cw↑UP- ccw↑
Net: ↑
UF+ ccw↑UP- ccw↑
Net: ccw↑
UP- cw↑UF+ cw↑
Net: cw↑
 UF- LB UP+ LB LB
(Y0, P0) Sitting 30° UF+ ccw↑ UF+ cw↑ UP- cw↑ UP- ccw↑
UF+ ccw↑UF+ cw↑
Net: UF+ ↑
UP- cw↑UP- ccw↑
Net: UP- ↑
UF+ ccw↑UP- cw↑
Net: ↑
UF+ cw↑UP- ccw↑
Net: ↑
UF+ ccw↑UP- ccw↑
Net: ccw↑
UP- cw↑UF+ cw↑
Net: cw↑
 UP+ RB UP+ LB Null
Baseline
(Y0, P0) Neutral 30° UF+ ccw↑ UF+ cw↑ UP- cw↑ UP- ccw↑
UF+ ccw↑UF+ cw↑
Net: UF+ ↑
UP- cw↑UP- ccw↑
Net: UP- ↑
UF+ ccw↑UP- cw↑
Net: ↑
UF+ cw↑UP- ccw↑
Net: ↑
UF+ ccw↑UP- ccw↑
Net: ccw↑
UP- cw↑UF+ cw↑
Net: cw↑
 UP+ RB UP+ LB Null
Supine Roll (P-60)
(Y0, P-60) SUP Center 90° UF+ ccw↑ UF+ cw↑ UP- cw↑ UP- ccw↑
UF+ ccw↑UF+ cw↑
Net: UF+ ↑
UP- cw↑UP- ccw↑
Net: UP- ↑
UF+ ccw↑UP- cw↑
Net: ↑
UF+ cw↑UP- ccw↑
Net: ↑
UF+ ccw↑UP- ccw↑
Net: ccw↑
UP- cw↑UF+ cw↑
Net: cw↑
 Null Null Null
(Y45, P-60) SUP Right 90° UF+++ ccw↑ Null Null UP--- ccw↑
UF+++ ccw↑Null
Net: UF+++ ccw↑
NullUP--- ccw↑
Net: UP--- ccw↑
UF+++ ccw↑Null
Net: UF+++ ccw↑
NullUP--- ccw↑
Net: UP--- ccw↑
UF+++ ccw↑UP--- ccw↑
Net: ccw↑
 Null UP+ RB UP+ LB Null
(Y60, P-60) SUP Right 90° UF+ ccw↑ UP- ccw↓ UF+ ccw↓ UP- ccw↑
UF+ ccw↑UP- ccw↓
Net: ccw
UF+ ccw↓UP- ccw↑
Net: ccw
UF+ ccw↑UF+ ccw↓
Net: UF+ ccw
UP- ccw↓UP- ccw↑
Net: UP- ccw
UF+ ccw↑UP- ccw↑
Net: ccw
UF+ ccw↓UP- ccw↓
Net: ccw↓
 UF- LB UP+ LB LB
(Y-45, P-60) SUP Left 90° Null UF+++ cw↑ UP--- cw↑ Null
NullUF+++ cw↑
Net: UF+++ cw↑
UP--- cw↑Null
Net: UP--- cw↑
NullUP--- cw↑
Net: UP--- cw↑
UF+++ cw↑Null
Net: UF+++ cw↑
 Null
UP--- cw↑UF+++ cw↑
Net: cw↑
 UP+ RB UF- RB RB
(Y-60, P-60) SUP Left 90° UP- cw↓ UF+ cw↑ UP- cw↑ UF+ cw↓
UP- cw↓UF+ cw↑
Net: cw
UP- cw↑UF+ cw↓
Net: cw
UP- cw↓UP- cw↑
Net: UP- cw
UF+ cw↑UF+ cw↓
Net: UF+ cw
UP- cw↓UF+ cw↓
Net: cw↓
UP- cw↑UF+ cw↑
Net: cw
 UP+ RB UF- RB RB
Supine Roll (P-75)
(Y0, P-75) SUP Center 105° UF+ ccw↑ UF+ cw↑ UP- cw↑ UP- ccw↑
UF+ ccw↑UF+ cw↑
Net: UF+ ↑
UP- cw↑UP- ccw↑
Net: UP- ↑
UF+ ccw↑UP- cw↑
Net: ↑
UF+ cw↑UP- ccw↑
Net: ↑
UF+ ccw↑UP- ccw↑
Net: ccw↑
UP- cw↑UF+ cw↑
Net: cw↑
 Null Null Null
(Y45, P-75) SUP Right 105° UF+++ ccw↑ Null Null UP--- ccw↑
UF+++ ccw↑Null
Net: UF+++ ccw↑
NullUP--- ccw↑
Net: UP--- ccw↑
UF+++ ccw↑Null
Net: UF+++ ccw↑
NullUP--- ccw↑
Net: UP--- ccw↑
UF+++ ccw↑UP--- ccw↑
Net: ccw↑
 Null UP+ RB UP+ LB Null
(Y60, P-75) SUP Right 105° UF+ ccw↑ UP- ccw↓ UF+ ccw↓ UP- ccw↑
UF+ ccw↑UP- ccw↓
Net: ccw
UF+ ccw↓UP- ccw↑
Net: ccw
UF+ ccw↑UF+ ccw↓
Net: UF+ ccw
UP- ccw↓UP- ccw↑
Net: UP- ccw
UF+ ccw↑UP- ccw↑
Net: ccw
UF+ ccw↓UP- ccw↓
Net: ccw↓
 UF- LB UP+ LB LB
(Y-45, P-75) SUP Left 105° Null UF+++ cw↑ UP--- cw↑ Null
NullUF+++ cw↑
Net: UF+++ cw↑
UP--- cw↑Null
Net: UP--- cw↑
NullUP--- cw↑
Net: UP--- cw↑
UF+++ cw↑Null
Net: UF+++ cw↑
 Null
UP--- cw↑UF+++ cw↑
Net: cw↑
 UP+ RB UF- RB RB
(Y-60, P-75) SUP Left 105° UP- cw↓ UF+ cw↑ UP- cw↑ UF+ cw↓
UP- cw↓UF+ cw↑
Net: cw
UP- cw↑UF+ cw↓
Net: cw
UP- cw↓UP- cw↑
Net: UP- cw
UF+ cw↑UF+ cw↓
Net: UF+ cw
UP- cw↓UF+ cw↓
Net: cw↓
UP- cw↑UF+ cw↑
Net: cw
 UP+ RB UF- RB RB
Supine Roll (P-90)
(Y0, P-90) SUP Center 120° UF+ ccw↑ UF+ cw↑ UP- cw↑ UP- ccw↑
UF+ ccw↑UF+ cw↑
Net: UF+ ↑
UP- cw↑UP- ccw↑
Net: UP- ↑
UF+ ccw↑UP- cw↑
Net: ↑
UF+ cw↑UP- ccw↑
Net: ↑
UF+ ccw↑UP- ccw↑
Net: ccw↑
UP- cw↑UF+ cw↑
Net: cw↑
 Null Null Null
(Y45, P-90) SUP Right 120° UF+++ ccw↑ Null Null UP--- ccw↑
UF+++ ccw↑Null
Net: UF+++ ccw↑
NullUP--- ccw↑
Net: UP--- ccw↑
UF+++ ccw↑Null
Net: UF+++ ccw↑
NullUP--- ccw↑
Net: UP--- ccw↑
UF+++ ccw↑UP--- ccw↑
Net: ccw↑
 Null UP+ RB UP+ LB Null
(Y60, P-90) SUP Right 120° UF+ ccw↑ UP- ccw↓ UF+ ccw↓ UP- ccw↑
UF+ ccw↑UP- ccw↓
Net: ccw
UF+ ccw↓UP- ccw↑
Net: ccw
UF+ ccw↑UF+ ccw↓
Net: UF+ ccw
UP- ccw↓UP- ccw↑
Net: UP- ccw
UF+ ccw↑UP- ccw↑
Net: ccw
UF+ ccw↓UP- ccw↓
Net: ccw↓
 UF- LB UP+ LB LB
(Y-45, P-90) SUP Left 120° Null UF+++ cw↑ UP--- cw↑ Null
NullUF+++ cw↑
Net: UF+++ cw↑
UP--- cw↑Null
Net: UP--- cw↑
NullUP--- cw↑
Net: UP--- cw↑
UF+++ cw↑Null
Net: UF+++ cw↑
 Null
UP--- cw↑UF+++ cw↑
Net: cw↑
 UP+ RB UF- RB RB
(Y-60, P-90) SUP Left 120° UP- cw↓ UF+ cw↑ UP- cw↑ UF+ cw↓
UP- cw↓UF+ cw↑
Net: cw
UP- cw↑UF+ cw↓
Net: cw
UP- cw↓UP- cw↑
Net: UP- cw
UF+ cw↑UF+ cw↓
Net: UF+ cw
UP- cw↓UF+ cw↓
Net: cw↓
UP- cw↑UF+ cw↑
Net: cw
 UP+ RB UF- RB RB
Step 1 Inverted Null Hold & Vibration Hold at null point with continuous occipital vibration
(Y45, P-150) (Y-45, P-150) (Y-45, P-150) (Y45, P-150) (Y±45, P-150) (Y±45, P-150) (Y±45, P-150) (Y±45, P-150) (Y45, P-150) (Y-45, P-150) (Y15/25, P-60) (Y-15/-25, P-60) —
Step 2 · Epley Omniax Repositioning Computer-Assisted Rotation Protocol Yaw (Y), pitch (Pr/P), and 360° rotational barrel roll
Y45, Pr-360X3 Right Posterior Y-45, Pr-360X3 Left Posterior Y-45, Pr360X3 Right Anterior Y45, Pr360X3 Left Anterior Y45, Pr-360X3; Y-45, Pr-360X3 Sequential roll Y-45, Pr360X3; Y45, Pr360X3 Sequential roll Y45, Pr-360X3; Y-45, Pr360X3 Sequential roll Y-45, Pr-360X3; Y45, Pr360X3 Sequential roll Y45: (P90+Pr-360)X3 Combination Protocol Y-45: (P90+Pr-360)X3 Combination Protocol Y0, P-75, Br to L x 3 Right Lateral 360° Barrel Roll Y0, P-75, Br to R x 3 Left Lateral 360° Barrel Roll — Sequential roll

Cupulolithiasis · Head Down (30°) Starting Position

Cupular dynamics starting from 30° head-down tilt with continuous occipital vibration at inverted null before liberatory roll.

Coords (Y, P) Position Grav ⊥ Right Posterior RP (Posterior) Left Posterior LP (Posterior) Right Anterior RA (Superior) Left Anterior LA (Superior) Right & Left Posterior Bilateral Posterior Right & Left Anterior Bilateral Anterior Right Post & Right Ant Ipsilateral Vertical R Left Post & Left Ant Ipsilateral Vertical L Right Post & Left Ant RALP Plane Right Ant & Left Post LARP Plane Right Lateral RL (Horizontal) Left Lateral LL (Horizontal) Right & Left Lateral Bilateral Lateral
Baseline
(Y0, P0) Neutral 0° Null Null Null Null Null Null Null Null Null Null Null Null Null
Dix-Hallpike Right (AD)
(Y45, P0) Dix AD 0° Null Null Null Null Null Null Null Null Null Null Null Null Null
(Y45, P-60) Dix AD 60° UF++ ccw↑ Null Null UP-- ccw↑
UF++ ccw↑Null
Net: UF++ ccw↑
NullUP-- ccw↑
Net: UP-- ccw↑
UF++ ccw↑Null
Net: UF++ ccw↑
NullUP-- ccw↑
Net: UP-- ccw↑
UF++ ccw↑UP-- ccw↑
Net: ccw↑
 Null UF- LB UP+ LB LB
(Y45, P-90) Dix AD 90° UF+++ ccw↑ Null Null UP--- ccw↑
UF+++ ccw↑Null
Net: UF+++ ccw↑
NullUP--- ccw↑
Net: UP--- ccw↑
UF+++ ccw↑Null
Net: UF+++ ccw↑
NullUP--- ccw↑
Net: UP--- ccw↑
UF+++ ccw↑UP--- ccw↑
Net: ccw↑
 Null UF- LB UP+ LB LB
(Y45, P-120) Dix AD 120° UF++++ ccw↑ Null Null UP---- ccw↑
UF++++ ccw↑Null
Net: UF++++ ccw↑
NullUP---- ccw↑
Net: UP---- ccw↑
UF++++ ccw↑Null
Net: UF++++ ccw↑
NullUP---- ccw↑
Net: UP---- ccw↑
UF++++ ccw↑UP---- ccw↑
Net: ccw↑
 Null UF- LB UP+ LB LB
(Y45, P-135) Dix AD 135° UF++++ ccw↑ Null Null UP---- ccw↑
UF++++ ccw↑Null
Net: UF++++ ccw↑
NullUP---- ccw↑
Net: UP---- ccw↑
UF++++ ccw↑Null
Net: UF++++ ccw↑
NullUP---- ccw↑
Net: UP---- ccw↑
UF++++ ccw↑UP---- ccw↑
Net: ccw↑
 Null UF- LB UP+ LB LB
(Y45, P-150) Dix AD 150° UF+++++ ccw↑ UF++ cw↑ UF++ ccw↓ UF++ cw↓
UF+++++ ccw↑UF++ cw↑
Net: UF+++ ccw↑
UF++ ccw↓UF++ cw↓
Net: UF++ ↓
UF+++++ ccw↑UF++ ccw↓
Net: UF+++ ccw
UF++ cw↑UF++ cw↓
Net: UF++ cw
UF+++++ ccw↑UF++ cw↓
Net: UF+++ ccw↑
UF++ ccw↓UF++ cw↑
Net: Null
 UP+ RB UF- RB RB
Sitting (AD Recovery)
(Y45, P0) Sitting 0° Null Null Null Null Null Null Null Null Null Null Null Null Null
(Y0, P0) Sitting 0° Null Null Null Null Null Null Null Null Null Null Null Null Null
Baseline
(Y0, P0) Neutral 0° Null Null Null Null Null Null Null Null Null Null Null Null Null
Dix-Hallpike Left (AS)
(Y-45, P0) Dix AS 0° Null Null Null Null Null Null Null Null Null Null Null Null Null
(Y-45, P-60) Dix AS 60° Null UF++ cw↑ UP-- cw↑ Null
NullUF++ cw↑
Net: UF++ cw↑
UP-- cw↑Null
Net: UP-- cw↑
NullUP-- cw↑
Net: UP-- cw↑
UF++ cw↑Null
Net: UF++ cw↑
 Null
UP-- cw↑UF++ cw↑
Net: cw↑
 UP+ RB UF- RB RB
(Y-45, P-90) Dix AS 90° Null UF+++ cw↑ UP--- cw↑ Null
NullUF+++ cw↑
Net: UF+++ cw↑
UP--- cw↑Null
Net: UP--- cw↑
NullUP--- cw↑
Net: UP--- cw↑
UF+++ cw↑Null
Net: UF+++ cw↑
 Null
UP--- cw↑UF+++ cw↑
Net: cw↑
 UP+ RB UF- RB RB
(Y-45, P-120) Dix AS 120° Null UF++++ cw↑ UP---- cw↑ Null
NullUF++++ cw↑
Net: UF++++ cw↑
UP---- cw↑Null
Net: UP---- cw↑
NullUP---- cw↑
Net: UP---- cw↑
UF++++ cw↑Null
Net: UF++++ cw↑
 Null
UP---- cw↑UF++++ cw↑
Net: cw↑
 UP+ RB UF- RB RB
(Y-45, P-135) Dix AS 135° Null UF+++++ cw↑ UP----- cw↑ Null
NullUF+++++ cw↑
Net: UF+++++ cw↑
UP----- cw↑Null
Net: UP----- cw↑
NullUP----- cw↑
Net: UP----- cw↑
UF+++++ cw↑Null
Net: UF+++++ cw↑
 Null
UP----- cw↑UF+++++ cw↑
Net: cw↑
 UP+ RB UF- RB RB
(Y-45, P-150) Dix AS 150° Null UF+++++ cw↑ UP----- cw↑ Null
NullUF+++++ cw↑
Net: UF+++++ cw↑
UP----- cw↑Null
Net: UP----- cw↑
NullUP----- cw↑
Net: UP----- cw↑
UF+++++ cw↑Null
Net: UF+++++ cw↑
 Null
UP----- cw↑UF+++++ cw↑
Net: cw↑
 UP+ RB UF- RB RB
Sitting (AS Recovery)
(Y-45, P0) Sitting 0° UP--(---) cw↓ UP--(---) ccw↓ UP--- cw↑ UP(---) ccw↑
UP--- cw↓UP--- ccw↓
Net: UP- ↓
UP--- cw↑UP--- ccw↑
Net: UP- ↑
UP--- cw↓UP--- cw↑
Net: cw
UP--- ccw↓UP--- ccw↑
Net: ccw
UP--- cw↓UP--- ccw↑
Net: Null
UP--- cw↑UP--- ccw↓
Net: Null
 UP+ RB UF- RB RB
(Y0, P0) Sitting 0° Null Null Null Null Null Null Null Null Null Null Null Null Null
Baseline
(Y0, P0) Neutral 0° Null Null Null Null Null Null Null Null Null Null Null Null Null
Supine Roll (P-75)
(Y0, P-75) SUP Center 75° UF+ ccw↑ UF+ cw↑ UP- cw↑ UP- ccw↑
UF+ ccw↑UF+ cw↑
Net: UF+ ↑
UP- cw↑UP- ccw↑
Net: UP- ↑
UF+ ccw↑UP- cw↑
Net: ↑
UF+ cw↑UP- ccw↑
Net: ↑
UF+ ccw↑UP- ccw↑
Net: ccw↑
UP- cw↑UF+ cw↑
Net: cw↑
 Null Null Null
(Y45, P-75) SUP Right 75° UF+++ ccw↑ Null Null UP--- ccw↑
UF+++ ccw↑Null
Net: UF+++ ccw↑
NullUP--- ccw↑
Net: UP--- ccw↑
UF+++ ccw↑Null
Net: UF+++ ccw↑
NullUP--- ccw↑
Net: UP--- ccw↑
UF+++ ccw↑UP--- ccw↑
Net: ccw↑
 Null UP+ RB UP+ LB Null
(Y60, P-75) SUP Right 75° UF+ ccw↑ UP- ccw↓ UF+ ccw↓ UP- ccw↑
UF+ ccw↑UP- ccw↓
Net: ccw
UF+ ccw↓UP- ccw↑
Net: ccw
UF+ ccw↑UF+ ccw↓
Net: UF+ ccw
UP- ccw↓UP- ccw↑
Net: UP- ccw
UF+ ccw↑UP- ccw↑
Net: ccw
UF+ ccw↓UP- ccw↓
Net: ccw↓
 UF- LB UP+ LB LB
(Y-45, P-75) SUP Left 75° Null UF+++ cw↑ UP--- cw↑ Null
NullUF+++ cw↑
Net: UF+++ cw↑
UP--- cw↑Null
Net: UP--- cw↑
NullUP--- cw↑
Net: UP--- cw↑
UF+++ cw↑Null
Net: UF+++ cw↑
 Null
UP--- cw↑UF+++ cw↑
Net: cw↑
 UP+ RB UF- RB RB
(Y-60, P-75) SUP Left 75° UP- cw↓ UF+ cw↑ UP- cw↑ UF+ cw↓
UP- cw↓UF+ cw↑
Net: cw
UP- cw↑UF+ cw↓
Net: cw
UP- cw↓UP- cw↑
Net: UP- cw
UF+ cw↑UF+ cw↓
Net: UF+ cw
UP- cw↓UF+ cw↓
Net: cw↓
UP- cw↑UF+ cw↑
Net: cw
 UP+ RB UF- RB RB
Supine Roll (P-90)
(Y0, P-90) SUP Center 90° UF+ ccw↑ UF+ cw↑ UP- cw↑ UP- ccw↑
UF+ ccw↑UF+ cw↑
Net: UF+ ↑
UP- cw↑UP- ccw↑
Net: UP- ↑
UF+ ccw↑UP- cw↑
Net: ↑
UF+ cw↑UP- ccw↑
Net: ↑
UF+ ccw↑UP- ccw↑
Net: ccw↑
UP- cw↑UF+ cw↑
Net: cw↑
 Null Null Null
(Y45, P-90) SUP Right 90° UF+++ ccw↑ Null Null UP--- ccw↑
UF+++ ccw↑Null
Net: UF+++ ccw↑
NullUP--- ccw↑
Net: UP--- ccw↑
UF+++ ccw↑Null
Net: UF+++ ccw↑
NullUP--- ccw↑
Net: UP--- ccw↑
UF+++ ccw↑UP--- ccw↑
Net: ccw↑
 Null UP+ RB UP+ LB Null
(Y60, P-90) SUP Right 90° UF+ ccw↑ UP- ccw↓ UF+ ccw↓ UP- ccw↑
UF+ ccw↑UP- ccw↓
Net: ccw
UF+ ccw↓UP- ccw↑
Net: ccw
UF+ ccw↑UF+ ccw↓
Net: UF+ ccw
UP- ccw↓UP- ccw↑
Net: UP- ccw
UF+ ccw↑UP- ccw↑
Net: ccw
UF+ ccw↓UP- ccw↓
Net: ccw↓
 UF- LB UP+ LB LB
(Y-45, P-90) SUP Left 90° Null UF+++ cw↑ UP--- cw↑ Null
NullUF+++ cw↑
Net: UF+++ cw↑
UP--- cw↑Null
Net: UP--- cw↑
NullUP--- cw↑
Net: UP--- cw↑
UF+++ cw↑Null
Net: UF+++ cw↑
 Null
UP--- cw↑UF+++ cw↑
Net: cw↑
 UP+ RB UF- RB RB
(Y-60, P-90) SUP Left 90° UP- cw↓ UF+ cw↑ UP- cw↑ UF+ cw↓
UP- cw↓UF+ cw↑
Net: cw
UP- cw↑UF+ cw↓
Net: cw
UP- cw↓UP- cw↑
Net: UP- cw
UF+ cw↑UF+ cw↓
Net: UF+ cw
UP- cw↓UF+ cw↓
Net: cw↓
UP- cw↑UF+ cw↑
Net: cw
 UP+ RB UF- RB RB
Supine Roll (P-120)
(Y0, P-120) SUP Center 120° UF+ ccw↑ UF+ cw↑ UP- cw↑ UP- ccw↑
UF+ ccw↑UF+ cw↑
Net: UF+ ↑
UP- cw↑UP- ccw↑
Net: UP- ↑
UF+ ccw↑UP- cw↑
Net: ↑
UF+ cw↑UP- ccw↑
Net: ↑
UF+ ccw↑UP- ccw↑
Net: ccw↑
UP- cw↑UF+ cw↑
Net: cw↑
 Null Null Null
(Y45, P-120) SUP Right 120° UF+++ ccw↑ Null Null UP--- ccw↑
UF+++ ccw↑Null
Net: UF+++ ccw↑
NullUP--- ccw↑
Net: UP--- ccw↑
UF+++ ccw↑Null
Net: UF+++ ccw↑
NullUP--- ccw↑
Net: UP--- ccw↑
UF+++ ccw↑UP--- ccw↑
Net: ccw↑
 Null UP+ RB UP+ LB Null
(Y60, P-120) SUP Right 120° UF+ ccw↑ UP- ccw↓ UF+ ccw↓ UP- ccw↑
UF+ ccw↑UP- ccw↓
Net: ccw
UF+ ccw↓UP- ccw↑
Net: ccw
UF+ ccw↑UF+ ccw↓
Net: UF+ ccw
UP- ccw↓UP- ccw↑
Net: UP- ccw
UF+ ccw↑UP- ccw↑
Net: ccw
UF+ ccw↓UP- ccw↓
Net: ccw↓
 UF- LB UP+ LB LB
(Y-45, P-120) SUP Left 120° Null UF+++ cw↑ UP--- cw↑ Null
NullUF+++ cw↑
Net: UF+++ cw↑
UP--- cw↑Null
Net: UP--- cw↑
NullUP--- cw↑
Net: UP--- cw↑
UF+++ cw↑Null
Net: UF+++ cw↑
 Null
UP--- cw↑UF+++ cw↑
Net: cw↑
 UP+ RB UF- RB RB
(Y-60, P-120) SUP Left 120° UP- cw↓ UF+ cw↑ UP- cw↑ UF+ cw↓
UP- cw↓UF+ cw↑
Net: cw
UP- cw↑UF+ cw↓
Net: cw
UP- cw↓UP- cw↑
Net: UP- cw
UF+ cw↑UF+ cw↓
Net: UF+ cw
UP- cw↓UF+ cw↓
Net: cw↓
UP- cw↑UF+ cw↑
Net: cw
 UP+ RB UF- RB RB
Step 1 Inverted Null Hold & Vibration Hold at null point with continuous occipital vibration
(Y45, P-180) (Y-45, P-180) (Y-45, P-180) (Y45, P-180) (Y±45, P-180) (Y±45, P-180) (Y±45, P-180) (Y±45, P-180) (Y45, P-180) (Y-45, P-180) (Y15/25, P-90) (Y-15/-25, P-90) —
Step 2 · Epley Omniax Repositioning Computer-Assisted Rotation Protocol Yaw (Y), pitch (Pr/P), and 360° rotational barrel roll
Y45, Pr-360X3 Right Posterior Y-45, Pr-360X3 Left Posterior Y-45, Pr360X3 Right Anterior Y45, Pr360X3 Left Anterior Y45, Pr-360X3; Y-45, Pr-360X3 Sequential roll Y-45, Pr360X3; Y45, Pr360X3 Sequential roll Y45, Pr-360X3; Y-45, Pr360X3 Sequential roll Y-45, Pr-360X3; Y45, Pr360X3 Sequential roll Y45: (P90+Pr-360)X3 Combination Protocol Y-45: (P90+Pr-360)X3 Combination Protocol Y0, P-75, Br to L x 3 Right Lateral 360° Barrel Roll Y0, P-75, Br to R x 3 Left Lateral 360° Barrel Roll — Sequential roll
Canalithiasis Head Neutral Chart Scan
Canalithiasis · Head Neutral Original high-resolution scan ↗
Canalithiasis Head Down Chart Scan
Canalithiasis · Head Down Original high-resolution scan ↗
Cupulolithiasis Head Neutral Chart Scan
Cupulolithiasis · Head Neutral Original high-resolution scan ↗
Cupulolithiasis Head Down Chart Scan
Cupulolithiasis · Head Down Original high-resolution scan ↗

© Ian Purcell MD PhD. Data extrapolated from Dr. Purcell’s original clinical matrices. Interactive format developed for Epley Omniax testing, high-gain rotational maneuvers, and clinical otoneurology characterization.

Extracted protocols

Single-canal treatment codes (summary)

Summarized from the chart treatment rows for quick chair setup. Always verify against the full matrix for combination columns and cupular null points.

Canalithiasis — rotational / barrel-roll codes

CanalHead-neutral chartHead-down chart
Right posteriorY45, P−360×2Y45, P−360×3
Left posteriorY−45, P−360×2Y−45, P−360×3
Right anteriorY−45, Pr+360×2Y45, P+360×3
Left anteriorY+45, Pr+360×2Y−45, P+360×3
Right lateralY0, P−75, Br to Left ×2Y0, P−75, Br to Left ×3
Left lateralY0, P−75, Br to Right ×2Y0, P−75, Br to Right ×3

Bilateral and cross-canal columns use sequential yaw components chosen by the most robust nystagmus, or a labeled combination protocol such as Y±45: (P+120 & Pr−360)×2 / (P+110 & Pr−360)×3.

Cupulolithiasis — two-step liberatory sequence

1 · Inverted null + vibration

Hold the patient at the canal’s inverted-null coordinate for 2–5 minutes (head-neutral charts) or 2–3 minutes (head-down charts) with occipital vibration. Example nulls: right posterior (Y45, P−150) neutral / (Y45, P−180) head-down.

2 · Slow or stepped 360° roll

Then either slow rotation with vibration at 10°/sec through the 360° component, or high-gain step accelerations every 30–90° through the barrel roll (as printed on each chart), typically …X3.

Lateral cupula variants

Lateral columns use inverted nulls near Y±15/25 with shallower pitch (e.g. P−60 / P−90), then Y0, P−75, Br to L/R ×3.

Hardware & Software Platform

Epley Omniax Chair & Diagnostic Suite

Computer-assisted multi-axis positioning paired with real-time infrared pupil tracking, 3D semicircular canal models, and continuous horizontal, vertical, and torsional (H/V/T) nystagmus recording—the precise diagnostic technology behind Dr. Purcell’s characterization matrices.

Explore the Epley Omniax Chair DizzyDoctor recording goggles Nystagmus video library
Epley Omniax multi-axis positioning chair in clinical testing suite Multi-Axis Chair

Motorized Positioning Chair

360° Rotational Gantry

Computer-driven 360° rotational positioning across pitch, yaw, and barrel-roll planes with integrated head restraint, ensuring precise alignment to gravitational coordinates for complex canalith repositioning.

  • Plane Yaw, pitch, and barrel roll
  • Protocol Automated liberatory maneuvers
  • Capability Inverted-null cupular alignment
Explore Chair Diagnostics
Epley Omniax software interface showing 3D canal model, pupil camera tracking, and H/V/T nystagmus traces Epley Omniax Software

Real-Time 3D Canal & Eye Tracking

Diagnostic Interface

High-speed infrared video pupilometry synced with live 3D anatomical semicircular canal models and multi-channel horizontal, vertical, and torsional (H/V/T) nystagmus velocity wave graphs.

  • Camera High-speed infrared pupilometry
  • Canal Model Dynamic 3D fluid & particle physics
  • Channels Continuous H, V, and T traces
View Tracking Software
Chair integration

Why these charts pair with the Epley Omniax

Bedside Dix-Hallpike and roll tests sample a few poses. The Epley Omniax holds precise yaw/pitch coordinates while goggles record nystagmus—exactly the grid these matrices describe.

Localization

Pattern across the grid

A single provocative position is rarely enough for multi-canal or cupular disease. Walking the chart rows distinguishes true canalithiasis from persistent cupular patterns.

Treatment

Codes map to chair axes

Yaw (Y), pitch (P/Pr), and barrel-roll (Br) instructions are written for computer-assisted multi-axis motion with optional vibration.

Verification

Retest the same cells

After repositioning, return to the provocative coordinates. Cleared cells and a null treatment column confirm success—or reveal canal conversion.

Attribution

Source charts

Canalithiasis · head neutralCanalithiasis · head downCupulolithiasis · head neutralCupulolithiasis · head down

Educational content only. © Ian Purcell MD PhD. Diagnosis and treatment must be individualized by a qualified clinician.

San Diego otoneurology

Complex positional patterns need a recorded matrix, not a guess

We use the DizzyDoctor goggles and Epley Omniax to match nystagmus across coordinates to the canal—and to the correct liberatory sequence.

Call (858) 223-2172