If patients with benign paroxysmal positional vertigo do not get the epley maneuver, will the otoconia stay stuck in semicircular canals forever, or do they eventually fall out naturally?

Probably not forever: Good question. The epley (; semont) maneuvers are relatively recent discoveries so in the not-too-distant past when people developed this type of vertigo it was usually self-limited (doctors used to blame it on viruses). Besides falling out, the otoconia may dissolve spontaneously. I theorize that herbs known to help dissolve kidney stones like chanca piedra ; golden coin grass might help this too.

Closed System: The maneuver is meant to reestablish the positions of the otoconia. The semicircular canals are a closed system, so they don't fall out they just are maneuvered into a different area.

See below: The otoliths usually are removed over time by movement. The epley maneuver can help to accelerate the process of removal. Please refer to your neurologist if you continue to have symptoms or have questions about the maneuver itself. Hope this helps!