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 Figure below, from Vats (Vats 2020), shows the Gufoni maneuver for left-sided geotropic lateral canal BPPV.
The Gufoni maneuver for left-sided geotropic lateral canal BPPV is as follows:
- The patient starts seated, with the head in a neutral position.
- The patient is brought to the side-lying position. For geotropic lateral canal BPPV, the patient will be lying on the unaffected ear — so for left-sided geotropic lateral canal BPPV, the patient will lie on their right side.
- The head is rotated 45 degrees in the yaw plane toward the ground. For left-sided geotropic lateral canal BPPV, the patient will be turning their head 45 degrees toward their right (toward the ground).
- The patient is brought back up to the seated position, with the head in a neutral position.
Gufoni/Appiani maneuver, geotropic lateral canal BPPV, left side, videos
- https://www.youtube.com/watch?v=MGbQGONbGsw (Balancing Act Resources)
The Gufoni/Appiani maneuver (geotropic variant) has been studied in a prospective trial with no control group (Riggio et al. 2009). It has also been studied in multiple prospective randomized controlled trial against the Lempert roll (Correia et al. 2022; Kim et al. 2012).
References
Correia F, Castelhano L, Cavilhas P, Escada P (2022) Lateral semicircular canal-BPPV: Prospective randomized study on the efficacy of four repositioning maneuvers. Acta Otorrinolaringol Esp (Engl Ed) 73: 27-34. doi: 10.1016/j.otoeng.2020.11.002
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, Kim HJ (2012) Randomized clinical trial for geotropic horizontal canal benign paroxysmal positional vertigo. Neurology 79: 700-7. doi: 10.1212/WNL.0b013e3182648b8b
Riggio F, Dispenza F, Gallina S, Kulamarva G, Gargano R, Speciale R (2009) Management of benign paroxysmal positional vertigo of lateral semicircular canal by Gufoni’s manoeuvre. Am J Otolaryngol 30: 106-11. doi: 10.1016/j.amjoto.2008.03.001
Vats AK (2020) The Clinical Spectrum of Patients of Horizontal Semicircular Canal Benign Paroxysmal Positional Vertigo Attending an Otoneurology Center in South Rajasthan, India and Their Response to Appropriate Repositioning Maneuvers at a Short-Term Follow-Up. Annals of Otology and Neurotology 3: 061-071. doi: 10.1055/s-0040-1715533
