Treatment for BPPV, lateral canal, geotropic, right side, modified Zuma maneuver

By Marcello Cherchi, MD PhD

The maneuver developed by Dr. Francisco Carlos Zuma e Maia (Zuma e Maia 2016) was originally designed to treat apogeotropic lateral canal BPPV. Ramos and colleagues (Ramos et al. 2021) created a modified Zuma maneuver to treat geotropic lateral canal BPPV.

The modified Zuma maneuver for treating right-sided geotropic lateral canal BPPV is shown in the Figure below, from Ramos and colleagues (Ramos et al. 2021).

Figure : Modified Zuma maneuver to treat right-sided geotropic lateral canal BPPV. From Ramos et al. (Ramos et al. 2021).

This maneuver can be described as follows:

1. The patient starts in a neutral seated position.
2. The patient turns the head 45 degrees toward the unaffected (left) side. (This head turn differs from the regular Zuma maneuver.)
3. The patient lies down on the affected (right) side, with the head still turned 45 degrees toward the unaffected side (with the nose pointing half-way between the surface of the earth and the sky).
4. The patient lies supine and turns the head such that the nose is pointing directly at the sky.
5. While the torso remains supine, the patient turns the head 90 degrees toward the unaffected (left) side, such that the nose is pointing in the plane of the earth’s surface.
6. The patient tilts the head up and slightly forward, then slowly returns to a seated position.

Another schematic depiction, also illustrating otolith positions, is shown in the Figure below from Ramos and colleagues (Ramos et al. 2022).

A similar schematic depiction of the modified Zuma maneuver for right-sided geotropic lateral canal BPPV is shown in the Figure below, from Zuma e Maia and colleagues (Zuma et al. 2020)

Modified Zuma maneuver, geotropic lateral canal BPPV, right side, videos

• As of this writing we were unable to identify any relevant videos.

The modified Zuma maneuver has been studied in a prospective trial without a control group (Ramos et al. 2021).

References

Ramos BF, Cal R, Brock CM, Mangabeira Albernaz PL, Zuma EMF (2021) Zuma Modified Maneuver as a Treatment to Geotropic Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo. Int Arch Otorhinolaryngol 25: e255-e257. doi: 10.1055/s-0040-1712935

Ramos BF, Cal R, Mangabeira Albernaz PL, Zuma EMF (2022) The role of the reversed nystagmus during Zuma maneuver in patients treated for geotropic lateral canal benign paroxysmal positional vertigo. J Neurol Sci 434: 120160. doi: 10.1016/j.jns.2022.120160

Zuma e Maia F (2016) New Treatment Strategy for Apogeotropic Horizontal Canal Benign Paroxysmal Positional Vertigo. Audiol Res 6: 163. doi: 10.4081/audiores.2016.163

Zuma EMF, Ramos BF, Cal R, Brock CM, Mangabeira Albernaz PL, Strupp M (2020) Management of Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo. Front Neurol 11: 1040. doi: 10.3389/fneur.2020.01040