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 maneuver developed by Dr. Augusto Pietro Casani and colleagues (Casani et al. 2011).
The Figure below, from Casani and colleagues (Casani et al. 2011), shows the Casani maneuver for treating anterior canal BPPV when it is bilateral or the side is unknown.
The Casani maneuver for treating anterior canal BPPV that is bilateral, or for which the side is unknown, can be described as follows:
- The patient starts in a neutral seated position.
- The patient moves the torso backward into a prone position, and extends the head to a straight head-hanging position (meaning that the head is midline and the head/neck is extended about 30 degrees below the edge of the table). This position is maintained for 3 minutes.
- The head/neck, while still midline, is inclined anteriorly (tucking the chin toward the chest) to about 30 degrees above the level of the table. This position is maintained for 3 minutes.
- The patient sits back up in a neutral position.
To us this maneuver appears substantially similar to the Yacovino maneuver. In the development of their maneuver, Casani and colleagues (Casani et al. 2011) cite Yacovino and colleagues (Yacovino et al. 2009).
Casani maneuver, videos
- https://www.youtube.com/watch?v=7KWFdCUaWzA (Dr. Michael Teichido)
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
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
