Treatment for BPPV, posterior canal, left side, Gans maneuver

By Marcello Cherchi, MD PhD

The Gans maneuver for treating posterior canal BPPV was published by Roberts and colleagues in 2006 (Roberts et al. 2006). Questions of priority arose when Califano (Califano 2017) pointed out that he and his colleagues had published this maneuver in 2003 (Califano et al. 2003), though comparison of the illustrations in the original articles shows them not to be identical, and the maneuver described by Califano and colleagues does not include the “head shaking” step described by Roberts and colleagues.

The Figure below, modified from the one shown in the original article by Roberts and colleagues (Roberts et al. 2006), is for treatment of left-sided posterior canal BPPV.

Here we paraphrase the description from Roberts and colleagues (Roberts et al. 2006) of the Gans maneuver for treating left-sided posterior canal BPPV.

1. The patient begins in a neutral seated position, facing forward. The patient turns the head 45 degrees to the unaffected (right) side and lies down on the affected (left) shoulder. (In this position, otoliths move from the ampullary segment of the posterior canal to the middle segment of the posterior canal.)
2. The patient rolls from the affected (left) shoulder on to the unaffected (right) shoulder, maintaining the head rotated 45 degrees to the unaffected (right) shoulder. (In this position the otoliths move from the middle segment of the posterior canal to the common crus.)
3. The patient shakes the head from side-to-side “three or four times.” (With this action, the otoliths traverse the common crus.)
4. The patient resumes a neutral seated position, with the head midline. (In this position, the otoliths enter the utricle.)

Gans maneuver, left posterior canal, videos

• https://dizzy.com/video-gans-repositioning-maneuver-grm-bed-roll-left-pc-bppv/
• https://www.youtube.com/watch?v=agtBvoaX6Rw

The Gans maneuver has been studied in multiple prospective trials without a control group (Gayathri et al. 2019; Roberts et al. 2006).  It has also been studied in multiple prospective randomized trials against the Epley maneuver (Dhiman et al. 2023; Saberi et al. 2017).  The Gans maneuver has also been studied in systematic reviews and meta-analyses (Joshi et al. 2022; Valsted et al. 2024).

References