Benign paroxysmal positional vertigo (BPPV) is the most common cause of recurrent vertigo. It is characterized by vertigo and nystagmus caused by a change in head position and horizontal semi-circular canal (HC)-BPPV is a sub-type of BPPV that accounts for many cases of persistent vertigo. One feature of this sub-type is direction-changing positional nystagmus (DCPN) which occurs when people suffering from this condition turns their head to the side.

Persistent DCPN in cases of vertigo are categorized as either geotropic or apogeotropic. A possible mechanism has been suggested to cause geotropic DCPN is canalolythiasis which is a gravity-dependent movement of particles in the inner ear. Apogeotropic DCPN is thought to be caused by cupulolithiasis in which occurs when debris in the inner ear is attached to the cupula. 1,2

Other suggested mechanisms of geotropic DCPN

Many different causative mechanism of DCPN have been hypothesized including: 2

Treatment of geotropic DCPN

Geotropic DCPN cannot be treated with repositioning manoeuvres as they are ineffective. This is exactly what led to the idea that this condition has no connection to free floating debris and instead it is associated with other mechanisms.

Transcutaneous vagus nerve stimulation is a therapy that has been proven to be successful in stimulating the vagus nerve (auricular branch) in chronic pain, certain forms of epilepsy, coronary heart disease and tinnitus. It has been suggested that transcutaneous vagus nerve stimulation can correct imbalances between the parasympathetic and sympathetic nervous systems. This therapy has been suggested as a highly effective and non-invasive way to manage persistent vertigo in people who suffer from geotropic DCPN. 2

The transcutaneous vagus nerve stimulation device

This transcutaneous (through the skin) device stimulates the vagus nerve’s afferent auricular branch.

It is safe to use and the side-effects are only minor and may include burning, tingling, slight pain and an itching sensation.

The transcutaneous vagus nerve stimulation device , however, is contraindicated in people who are pregnant or those who suffer from heart disease, alcoholism, head trauma, migraines, drug misuse, psychiatric disorders and people who have metal implants (like pacemakers) and cochlear implants. 3

In the future

Transcutaneous vagus nerve stimulation may prove to be a useful tool for further investigation because of its effect on neuromodulation. More research is still needed to explore more possibilities of this type of therapy and its benefits for the human body, especially as far as persistent vertigo is concerned.

If you suffer from persistent vertigo, get help now: Call Brain Hub on 1300 770 197 now!




  1. Kim C, Kim M, Ban JH. Persistent Geotropic Direction-Changing Positional Nystagmus with a null plane: The light cupula. Laryngoscope. 2014; 124:E15–E19.
  2. Cha WW, Song K, Lee HY. Letter to the editor: Persistent Geotropic Direction-Changing Positional Nystagmus Treated with Transcutaneous Vagus Nerve Stimulation. Brain Stimulation. 2016; 9(3): 469-470.
  3. Van Leusden JWR, Sellaro R, Colzato LS. Transcutaneous vagal nerve stimulation (tVNS): a new neuromodulation tool in healthy humans? Front Psychol. 2015; 6: 102.


Dr Carlo Rinaudo (Chiropractor and PhD candidate) is the clinic director of Brain Hub, a clinic in Sydney focussed on helping people with dizziness and vertigo conditions, poor balance, whiplash and concussion symptoms.

The clinic and its practitioners use a range of modalities to help assess and manage these conditions and/or symptoms. Vestibular rehabilitation therapy and other brain-based therapies are primarily utilised, along with standard Chiropractic and physical therapy techniques.

The growing evidence showing support for the management of these conditions comes primarily from the physical therapy and clinical neuroscience fields, rather than chiropractic specific. Fortunately, Dr Rinaudo with post-graduate training both in Australia and from overseas is experienced to translate this knowledge into clinical practice. Additionally, he is currently undertaking a PhD from the University of New South Wales (UNSW) and Neuroscience Research Australia (  in Vestibular Therapy, more specifically clinical trials on how to help people with dizziness and vertigo conditions. He is working alongside leading researchers and Neurologists in the field. Additionally, the benefits expected from his PhD research will be used to further validate the use of vestibular rehabilitation therapy for other related conditions like whiplash and concussions.

Dr Rinaudo is a frequent speaker at national events, as well as lecturer in the field of vestibular rehabilitation and dizziness conditions to other health practitioners.