Canalith repositioning maneuvers take the spin out of vertigo

By Lucy Piper, Senior medwireNews Reporter

Barbecue rotation and Gufoni maneuvers are effective for treating geotropic type benign paroxysmal positional vertigo involving the horizontal semicircular canal (HC-BPPV), study findings show.

Sun-Young Oh (Chonbuk National University Hospital, Jeonju, South Korea) and colleagues found that after a maximum of two sessions on the initial visit day, vertigo and nystagmus immediately resolved in 69.1% of HC-BPPV patients receiving the barbecue rotation maneuver and in 60.9% of those receiving the Gufoni maneuver.

This compared with just 35.4% of patients receiving a sham maneuver.

"The objective of canalith repositioning maneuvers for geotropic HC-BPPV is to enable the otoconial debris to shift out of the nonampullated end of the horizontal semicircular canal into the utricle," the study researchers explain.

They randomly assigned 170 patients, aged 11-97 years, with geotropic HC-BPPV to treatment with the barbecue rotation (n=56), Gufoni maneuver (n=64), or sham maneuver (n=50).

For the barbecue rotation maneuver, the patients underwent a quick stepwise 90° rotation of the head from the affected ear-down to nose-down positions in the direction of the healthy ear. Each position was maintained for 30-60 seconds until the induced nystagmus dissipated.

Patients receiving the Gufoni maneuver were quickly brought down on the healthy side from the sitting position and remained in this position for 2 minutes, after which the head was turned about 45° down, so that the nose was on the bed. After 2 minutes in this position, the patient was returned to the upright position.

The sham maneuver involved the patient lying down from the sitting position for 30 seconds, after which their head was turned 90° to the affected side for 1 minute and then they were returned to the sitting position.

Treatment response determined for 167 of the participants within 1 hour of receiving two sessions on an initial visit showed that the barbecue rotation maneuver was 4.07 times more effective than the sham maneuver and the Gufoni maneuver was 2.84 times more effective. There was no significant difference between the two active interventions, however.

The absolute risk reductions versus the sham maneuver were 0.34 for the barbecue rotation and 0.25 for the Gufoni maneuver. The respective numbers needed to treat were 2.97 and 3.92.

The researchers note in Neurology that the therapeutic effects of the barbecue rotation and Gufoni maneuvers remained superior to the sham maneuver 1 month after treatment.

Both treatments were well tolerated, with only 1.8% of patients receiving active treatment transitioning to benign paroxysmal positional vertigo involving the posterior semicircular canal, and a low recurrence rate of 4.1%.

"This study provides Class I evidence that barbecue rotation and Gufoni maneuvers are effective in the treatment of HC-BPPV," the team concludes.

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