Even though benign paroxysmal positional vertigo (BPPV) mostly affects a single semicircular canal (SCC), BPPV simultaneously involving more than one SCC is not rare. This multi-canal BPPV may either involve the same canals on both sides or simultaneously affect different canals on the same or on both sides. Since the SCCs can be involved in various combinations in one or both ears, multi-canal BPPVs pose diagnostic and therapeutic challenges. The different patterns of nystagmus induced during each positional maneuver should be differentiated from positional vertigo and nystagmus due to central lesions. It remains unknown which canal should be treated first and which maneuver should be adopted for multi-canal BPPVs. Furthermore, the optimal interval from treatment of a canal to another should be determined. The response to canalith repositioning maneuvers and recurrences do not differ between multi- and single canal BPPVs in spite of more frequent involvement of multiple canals in traumatic cases.