Most of you who do repositioning manoeuvres, you're always warned about this drop attack phenomena. If you're not familiar with it, I'll just explain it. So you're doing an Epley manoeuvre and when you finish and bring the patient back up to the sitting position, most people recommend that you don't let the patient go. Because in some instances, the patient suddenly drops to the floor, what you're seeing there is the effect of the otoconia that is coming out of the canal, and then shearing the saccule or landing on top of the utricle. This gives the patient the sensation that they're falling, they're getting pulled down.
If you are talking about immediately after the repositioning manoeuvre, yes, there's a potential for those particles actually landing on the utricle, or shearing the saccule to give you that effect. Now, long term, we don't know what happens. With patients who have had BPPV, there's been at least three good reports that show oVEMP abnormalities in these patients. That tells us that there's a long term utricular dysfunction in these patients. So long term, it's not clear what happens to the otoconia, whether it goes back to the utricle, whether it gets dissolved, regardless, it doesn't repair what's happened to the utricle, at least not to the best of our knowledge.