By Marcello Cherchi, MD PhD
Less commonly used maneuvers for treatment of lateral canal BPPV include that developed by Dr. Mauro Gufoni and colleagues (Gufoni et al. 1998). The maneuver subsequently described by Dr. Mario Ciniglio Appiani (Ciniglio Appiani et al. 2005) is identical.
The Figure below, from Straumann and Brandt (Straumann and Brandt 2020), shows the Gufoni maneuver for left-sided apogeotropic lateral canal BPPV.
The Gufoni maneuver for left-sided apogeotropic lateral canal BPPV can be described as follows.
- The patient starts seated, with the head in a neutral position.
- The patient is brought to the side-lying position. For apogeotropic lateral canal BPPV, the patient will be lying on the affected ear — so for left-sided apogeotropic lateral canal BPPV, the patient will lie on their left side.
- The head is rotated 45 degrees in the yaw plane toward the sky. For left-sided apogeotropic lateral canal BPPV, the patient will be turning their head 45 degrees toward their right (toward the sky).
- The patient is brought back up to the seated position, with the head in a neutral position.
The Figure below, from Ciniglio Appiani and colleagues (Ciniglio Appiani et al. 2005), shows the left-sided Appiani maneuver for left-sided lateral canal apogeotropic BPPV.
Gufoni/Appiani maneuver, apogeotropic lateral canal BPPV, left side, videos
The Gufoni/Appiani maneuver (apogeotropic variant) (Gufoni et al. 1998) has been studied in multiple randomized controlled trials:
- Against therapeutic head shaking (Kim et al. 2012; Lee et al. 2023).
- Against the Appiani maneuver (Lee et al. 2021).
References
Ciniglio Appiani G, Catania G, Gagliardi M, Cuiuli G (2005) Repositioning maneuver for the treatment of the apogeotropic variant of horizontal canal benign paroxysmal positional vertigo. Otol Neurotol 26: 257-60. doi: 10.1097/00129492-200503000-00022
Gufoni M, Mastrosimone L, Di Nasso F (1998) [Repositioning maneuver in benign paroxysmal vertigo of horizontal semicircular canal]. Acta Otorhinolaryngol Ital 18: 363-7.
Kim JS, Oh SY, Lee SH, Kang JH, Kim DU, Jeong SH, Choi KD, Moon IS, Kim BK, Oh HJ, Kim HJ (2012) Randomized clinical trial for apogeotropic horizontal canal benign paroxysmal positional vertigo. Neurology 78: 159-66. doi: 10.1212/WNL.0b013e31823fcd26
Lee HJ, Jeon EJ, Nam S, Mun SK, Yoo SY, Bu SH, Choi JW, Chung JH, Hong SM, Lee SH, Kim MB, Koo JW, Kim HJ, Seo JH, Ahn SK, Park SN, Kim M, Chung WH (2023) Treatment Efficacy of Various Maneuvers for Lateral Canal Benign Paroxysmal Positional Vertigo With Apogeotropic Nystagmus: A Randomized Controlled Trial. Clin Exp Otorhinolaryngol 16: 251-258. doi: 10.21053/ceo.2023.00619
Lee J, Lee DH, Noh H, Shin JE, Kim CH (2021) Immediate and short-term effects of Gufoni and Appiani liberatory maneuver for treatment of ageotropic horizontal canal benign paroxysmal positional vertigo: A prospective randomized trial. Laryngoscope Investig Otolaryngol 6: 832-838. doi: 10.1002/lio2.600
Straumann D, Brandt T (2020) Bedside provocation and liberation maneuvers in patients with benign paroxysmal positional vertigo. Clinical and Translational Neuroscience 4: 2514183X19881892. doi: 10.1177/2514183X19881892
