Rossi Izquierdo, MarcosSantos Pérez, Sofía María de la SoledadArán Tapia, IsmaelBlanco Ulla, MiguelArán González, IsmaelVaamonde Sánchez-Andrade, IsabelFranco-Gutiérrez, VirginiaPérez Muñuzuri, VicentePérez Muñuzuri, AlbertoSoto Varela, Andrés2026-04-072026-04-072025Rossi-Izquierdo, M., Santos-Pérez, S., Arán-Tapia, I., Blanco-Ulla, M., Arán-González, I., Vaamonde-Sánchez-Andrade, I., Franco-Gutiérrez, V., Pérez-Muñuzuri, V., Muñuzuri, A. P., & Soto-Varela, A. (2025). Personalized medicine to treat refractory benign paroxysmal positional vertigo, through computational fluid dynamics analysis from magnetic resonance image reconstructions. Frontiers in Neurology, 16. https://doi.org/10.3389/FNEUR.2025.1561356https://hdl.handle.net/10347/46589Background: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo, often effectively treated with standard canalith repositioning maneuvers (CRMs). However, approximately 12.5% of cases remain refractory, leading to persistent symptoms and increased healthcare burden. Variations in the anatomical orientation of the semicircular canals (SCCs) may explain the resistance to conventional maneuvers. This study explores a personalized medicine approach, utilizing computational fluid dynamics (CFD) based on MRI reconstructions to tailor CRMs with the help of mechanical rotation chair according to individual inner ear anatomy. Methods: We conducted a randomized, multicenter, open-label study targeting patients with refractory posterior canal BPPV. Participants were allocated to either a control group (receiving repeated standard CRMs and Brandt-Daroff exercises) or an intervention group (receiving personalized CRMs based on CFD simulations derived from MRI scans). The intervention group’s maneuvers were executed using a mechanical rotational chair designed for precise angulation. Primary outcomes included resolution of nystagmus and vertigo symptoms, while secondary outcomes measured the reduction in healthcare visits and improved quality of life (Dizziness Handicap Inventory score). Discussion: Personalized CRMs based on CFD models may enhance treatment efficacy for refractory BPPV by optimizing maneuver angles according to the specific SCC orientation. This approach could significantly reduce symptom persistence, decrease the need for repeated healthcare visits, and improve patient outcomes. The use of non-invasive MRI and CFD techniques represents a novel step toward individualized treatment in vestibular disorders, with potential for broader application in personalized otoneurology. Further analysis will determine the extent of clinical benefit and cost-effectiveness of this approach. Clinical trial registration: ClinicalTrials.gov, Identifier: NCT06725966.eng© 2025 Rossi-Izquierdo, Santos-Pérez, Arán-Tapia, Blanco-Ulla, Arán-González, Vaamonde-Sánchez-Andrade, Franco-Gutiérrez, Pérez-Muñuzuri, Muñuzuri and Soto-Varela. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.Attribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/Benign paroxysmal positional vertigoCanalith repositioning maneuversComputational fluid dynamicsMechanical rotation chairMRIjournal article2026-04-0610.3389/FNEUR.2025.15613561664-2295open access1664-2295