Benign paroxysmal positional vertigo (BPPV) of the anterior semicircular canal (ASC) is an uncommon disorder currently diagnosed with the Dix-Hallpike (D-H) examination. According to the literature, nystagmus and vertigo may be more pronounced when the affected ear is either up or down. In some patients, both right and left D-H tests can trigger nystagmus with the same direction. The proposed treatment options with the addition of a different manoeuvre applied by the authors of the present study in cases of ASC lithiasis, seem to present a respective variety regarding the position of the affected ASC during the procedure of canalith repositioning. The aim of this study is to analyse the mechanisms underlying both the proposed treatment options and the clinical findings in the D-H examination. The results of this analysis stimulate further investigation, since they probably imply that repositioning manoeuvres might vary in their effectiveness when applied to different clinical subgroups of ASC BPPV.