By Marcello Cherchi, MD PhD
For cases of anterior canal BPPV that are bilateral, or for which the affected side is unknown, reasonable approaches include the “prolonged forced position procedure” described by Dr. Luc Crevits (Crevits 2004).
Dr. Crevits describes the procedure as follows:
“The patient was rapidly moved from sitting to lying supine with the head bent backwards as far as possible — that is, with the vertex about 60˚ below the horizontal. The head was supported in this hanging position for 30 minutes…
Then the head was moved quickly forwards, as far as possible — that is, with the vertex near vertical… In this forced position, the head was fastened with the help of a pulley system that allowed the head to hang slightly. The patient was not allowed to stand up. After 24 hours, the patient was asked to sit and stay in the sitting position with the head straight for some minutes.”
The Figure below shows the illustrations that Crevits (Crevits 2004) provides of the intended labyrinth positions in the first and second positions.
The article by Crevits (Crevits 2004) does not give an illustration of a patient in the first (head hanging) position, but does provides a photograph of a patient in the second position (head inclined nearly vertically), shown in the Figure below.
The description of these positions is similar to those of the Yacovino maneuver (Yacovino et al. 2009) and Casani maneuver (Casani et al. 2011), with the main difference being the long time (30 minutes) in the first position, and the extraordinarily long time (24 hours) in the second position. Dr. Crevits notes that his patients were hospitalized for this maneuver.
We think it is impractical to hospitalize patients for treatment of BPPV, particularly given the reported efficacy of alternative maneuvers.
References
Casani AP, Cerchiai N, Dallan I, Sellari-Franceschini S (2011) Anterior canal lithiasis: diagnosis and treatment. Otolaryngol Head Neck Surg 144: 412-8. doi: 10.1177/0194599810393879
Crevits L (2004) Treatment of anterior canal benign paroxysmal positional vertigo by a prolonged forced position procedure. J Neurol Neurosurg Psychiatry 75: 779-81.
Yacovino DA, Hain TC, Gualtieri F (2009) New therapeutic maneuver for anterior canal benign paroxysmal positional vertigo. J Neurol 256: 1851-5. doi: 10.1007/s00415-009-5208-1
