Treatment for BPPV, lateral canal, geotropic, right side, Gufoni-Appiani maneuver

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 Straumann and Brandt (Straumann and Brandt 2020), shows the Gufoni maneuver for right-sided geotropic lateral canal BPPV.

Figure: Gufoni maneuver for right-sided geotropic lateral canal BPPV. From Straumann and Brandt (Straumann and Brandt 2020).
Figure: Gufoni maneuver for right-sided geotropic lateral canal BPPV. From Straumann and Brandt (Straumann and Brandt 2020).

The Gufoni maneuver for right-sided geotropic lateral canal BPPV is as follows:

  1. The patient starts seated, with the head in a neutral position.
  2. 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 right-sided geotropic lateral canal BPPV, the patient will lie on their left side.
  3. The head is rotated 45 degrees in the yaw plane toward the ground. For right-sided geotropic lateral canal BPPV, the patient will be turning their head 45 degrees toward their left (toward the ground).
  4. The patient is brought back up to the seated position, with the head in a neutral position.

The Figure below, from Bhattacharyya and colleagues (Bhattacharyya et al. 2017), shows the Gufoni maneuver for treating right-sided geotropic lateral canal BPPV.

Figure: Gufoni maneuver for right-sided lateral canal BPPV, geotropic variant. From Bhattacharyya et al. (2017).
Figure: Gufoni maneuver for right-sided lateral canal BPPV, geotropic variant. From Bhattacharyya et al. (2017).

Gufoni/Appiani maneuver, geotropic lateral canal, right side, videos

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

Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T, Holmberg JM, Mahoney K, Hollingsworth DB, Roberts R, Seidman MD, Steiner RW, Do BT, Voelker CC, Waguespack RW, Corrigan MD (2017) Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngol Head Neck Surg 156: S1-S47. doi: 10.1177/0194599816689667

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

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

Page first published on February 24, 2025. Page last updated on April 9, 2025

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