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Extended Reality (XR) for precision guidance in canalith repositioning maneuvers: a scoping review
Muhammad Anas Ismail1, Nor Kamaruzaman Esa2, Mohd Sayuti Razali2
1Department of Otorhinolaryngology, Hospital Sultan Zainal Abidin, Kuala Terengganu, Terengganu, Malaysia.
Purpose:
The Canalith Repositioning Maneuver (CRM) is the gold-standard treatment for Benign Paroxysmal Positional Vertigo (BPPV), but its success relies heavily on strict angular precision. Clinical estimation of head angles introduces substantial execution variability, leading to maneuver failure. Extended Reality (XR) and wearable sensors offer a promising solution by providing real-time biomechanical guidance. This scoping review systematically maps the emerging evidence on XR technologies for sensor-guided precision control during CRMs.
Methods:
Following PRISMA-ScR guidelines, a systematic search was conducted across PubMed, Scopus, Cochrane CENTRAL, and IEEE Xplore for studies published between January 2010 and December 2025. Eligible studies evaluated Head-Mounted Displays (HMDs) or comparable wearable devices integrated with motion-tracking technologies for CRM execution. Data were synthesized using a convergent narrative approach.
Results:
Six studies met the inclusion criteria, comprising clinical feasibility trials (n = 3) and computational simulation studies (n = 3). Hardware predominantly included smartphone-based Virtual Reality (VR) and custom head-mounted Inertial Measurement Units (IMUs) utilizing visual or auditory feedback. Clinical evidence demonstrated that sensor-guided feedback significantly minimized angular positional errors compared to standard unguided maneuvers. Concurrently, advanced 3D simulations successfully mapped inner ear biomechanics and validated optimized maneuver pathways.
Conclusion:
XR and motion-tracking technologies effectively standardize CRM angular precision. By reducing execution variability, these systems can ensure consistent, expert-level care among clinicians and ultimately democratize execution to enable safe, highly effective self-treatment for patients at home. Future research must prioritize large-scale comparative effectiveness trials and evaluate Mixed Reality (MR) systems to mitigate visual occlusion and fall risks.
