Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder. It is a result of displaced otoconia within the semicircular canals and is treated with particle repositioning maneuvers (PRMs). However, recurrence of the condition can be due to several factors including sub-optimal repositioning during PRMs or conversion to other affected semicircular canals. Patient factors of age, chronic back pain, and atypical involvement of the semicircular canals can also result in recalcitrant BPPV. Repositioning chairs have been used since the late 1990s to treat these select patient populations. These chairs, including the Omniax system and TRV chair, have shown high efficacy but are not readily available. In this chapter, we provide a detailed overview of the repositioning chair and its role in BPPV treatment.