By Marcello Cherchi, MD PhD
In cases where posterior canal BPPV is truly present on both sides, or cases in which there is good reason to believe that a patient has posterior canal involvement but the side is unknown, it is reasonable to attempt the Brandt-Daroff maneuver (Brandt and Daroff 1980), originally described by neurologists Dr. Thomas Brandt and Dr. Robert Daroff.
The Figure below shows the Brandt-Daroff maneuver for treating posterior canal benign paroxysmal positional vertigo that is either bilateral or whose side is unknown, as illustrated in the original paper by Brandt and Daroff (Brandt and Daroff 1980).
The Brandt-Daroff maneuver for treatment of posterior canal BPPV when it is bilateral, or when the affected side is unknown, is as follows:
- The patient begins in a neutral seated position.
- The patient lies down on one shoulder, with the head rotated 45 degrees toward the uppermost shoulder, and maintains this position for 30 seconds.
- The patient resumes a neutral seated position.
- The patient lies down on the other shoulder, with the head rotated 45 degrees toward the uppermost shoulder, and maintains this position for 30 seconds.
- The patient resumes a neutral seated position.
The Figure below, from Bittar and colleagues (Bittar et al. 2011), more clearly illustrates the rotated head position.
Brandt-Daroff maneuver, videos
- https://www.youtube.com/watch?v=CTZfIv165sY (Dr. Michael Teichido)
- https://www.youtube.com/watch?v=voZXtTUdQ00 (Wendy Carender, University of Michigan)
- https://www.youtube.com/watch?v=h8iWUGiiHYQ (Vertin)
- https://www.youtube.com/watch?v=XD6OyE1N-hY (Dr. Gregg Bingham, Oakwood Surgery)
- https://www.youtube.com/watch?v=AUbSIEjj2yc (AJ Ludlow, Stronglife PT)
The Brandt-Daroff maneuver (Brandt and Daroff 1980) has been studied in multiple prospective randomized trials:
- Against the Epley maneuver (Celis-Aguilar et al. 2022; Cetin et al. 2018; Choi et al. 2020; Soto Varela et al. 2001).
- Against the Semont maneuver (Celis-Aguilar et al. 2022; Soto Varela et al. 2001).
- Against the Foster maneuver (Jaffar et al. 2023).
The Brandt-Daroff maneuver has also been studied in a systematic review (Alashram 2024).
References
Alashram AR (2024) Effectiveness of brandt-daroff exercises in the treatment of benign paroxysmal positional vertigo: a systematic review of randomized controlled trials. Eur Arch Otorhinolaryngol 281: 3371-3384. doi: 10.1007/s00405-024-08502-6
Bittar RS, Mezzalira RM, Furtado PL, Venosa AR, Sampaio AL, Pires de Oliveira CA (2011) Benign paroxysmal positional vertigo: diagnosis and treatment. Int Tinnitus J 16: 135-45.
Brandt T, Daroff RB (1980) Physical therapy for benign paroxysmal positional vertigo. Arch Otolaryngol 106: 484-5. doi: 10.1001/archotol.1980.00790320036009
Celis-Aguilar E, Mayoral-Flores HO, Torrontegui-Zazueta LA, Medina-Cabrera CA, Leon-Leyva IC, Dehesa-Lopez E (2022) Effectiveness of Brandt Daroff, Semont and Epley maneuvers in the treatment of Benign Paroxysmal Positional Vertigo: A Randomized Controlled Clinical Trial. Indian J Otolaryngol Head Neck Surg 74: 314-321. doi: 10.1007/s12070-021-02516-w
Cetin YS, Ozmen OA, Demir UL, Kasapoglu F, Basut O, Coskun H (2018) Comparison of the effectiveness of Brandt-Daroff Vestibular training and Epley Canalith repositioning maneuver in benign Paroxysmal positional vertigo long term result: A randomized prospective clinical trial. Pak J Med Sci 34: 558-563. doi: 10.12669/pjms.343.14786
Choi SY, Cho JW, Choi JH, Oh EH, Choi KD (2020) Effect of the Epley Maneuver and Brandt-Daroff Exercise on Benign Paroxysmal Positional Vertigo Involving the Posterior Semicircular Canal Cupulolithiasis: A Randomized Clinical Trial. Front Neurol 11: 603541. doi: 10.3389/fneur.2020.603541
Jaffar M, Ghous M, Ayaz M, Khan AA, Akbar A, Haleem F (2023) Effects of Half-Somersault and Brandt-Daroff exercise on dizziness, fear of fall and quality of life in patients with posterior canal benign paroxysmal positional vertigo: A randomised control trial. J Pak Med Assoc 73: 139-142. doi: 10.47391/JPMA.3333
Soto Varela A, Bartual Magro J, Santos Perez S, Velez Regueiro M, Lechuga Garcia R, Perez-Carro Rios A, Caballero L (2001) Benign paroxysmal vertigo: a comparative prospective study of the efficacy of Brandt and Daroff exercises, Semont and Epley maneuver. Rev Laryngol Otol Rhinol (Bord) 122: 179-83.
