Horizontal Canal BPPV Maneuvers

[Cally Chang]

Hi there,

I am having difficulty understanding which maneuvers for Horizontal BPPV are appropriate. For example, the Medbridge course mentioned for Horizontal Canalithiasis the Gufoni’s Maneuver should be utilized and for Horizontal Cupulolithiasis the Kims Maneuver should be used (although less evidence to support this maneuver).

In the Shepherd & Adams book, in one of the answer descriptions they mentioned the Lempert 360 deg (BBQ roll) and the modified Gufoni and/or Liberatory maneuver.

Perhaps I am misunderstanding, but would someone please help clear this up for me? Specifically, what maneuvers should be used for Horizontal Canalithiasis and Horizontal Cupulolithiais. Thank you in advance!

[Masato Kobayashi]

Vestibular nerd here, so I want to give this a shot. Chrissy and the rest of the NCS Advantage community – correct me if I am wrong!

Cally, totally understandable to be confused about which CRMs are appropriate for each type of BPPV. There are so many variations/types of CRMs!

For horizontal canalithiasis, both the BBQ roll and the Gufoni maneuver can be used.

For horizontal cupulolithiasis, the Kim maneuver can definitely be used but be aware that there is a version of Gufoni maneuver that can also be used to treat this type of BPPV (this is where some confusion can arise).

Really important to be able to identify the involved side with horizontal canalithiasis so you know which CRM to ultimately use – another area that can stump clinicians.

I would recommend being familiar with the BPPV CPG – Bhattacharyya, N., Gubbels, S. P., Schwartz, S. R., Edlow, J. A., El-Kashlan, H., Fife, T., Holmberg, J. M., Mahoney, K., Hollingsworth, D. B., Roberts, R., Seidman, M. D., Steiner, R. W., Do, B. T., Voelker, C. C., Waguespack, R. W., & Corrigan, M. D. (2017). Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngology–head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 156(3_suppl), S1–S47. https://doi.org/10.1177/0194599816689667.

Just be aware – the more you deep dive into vestibular literature, the more you may get confused with all the variations of CRMs! I would start with this CPG and know the foundational/highly researched maneuvers. Hope this helps! Happy to expand if needed.

[Chrissy Durrough Lugge]

Thank you, Masato, for tackling this one! I am caught in the Nashville ice storm and have been without power for 9 days and counting…trying to catch up on emails and forums when the kids are napping and we have sufficient battery!

Cally- I agree with what Masato said about being familiar with recognizing BPPV type and having a general understanding of the big maneuvers. Honestly, if you understand PSC canalithiasis and the Epley, you’re probably good to go. The NCS usually doesn’t get too in the weeds of BPPV, especially since there is so much variability in recommendations. I’ve been saying for my whole career there should be a VCS exam!!!

[Chrissy Durrough Lugge]

Thank you, Masato, for tackling this one! I am caught in the Nashville ice storm and have been without power for 9 days and counting…trying to catch up on emails and forums when the kids are napping and we have sufficient battery!

Cally- I agree with what Masato said about being familiar with recognizing BPPV type and having a general understanding of the big maneuvers. Honestly, if you understand PSC canalithiasis and the Epley, you’re probably good to go. The NCS usually doesn’t get too in the weeds of BPPV, especially since there is so much variability in recommendations. I’ve been saying for my whole career there should be a VCS exam!!!

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