Vestibular

[Margaret Blevins]

Hello!
Two questions: Should I anticipate NCS test questions to be specific in asking what positions the head or direction of sidelying for each maneuver? Or just to the extent of recognizing which canal is involved, direction of nystagmus and choosing the appropriate test and CRM?

If we need to know specifics of the positions for each CRM… I am confused on the horizontal canal treatments for canalithiasis vs cupulolithiasis and how they differ for geotropic vs ageotropic. I feel that the powerpoint notes don’t quite match the CPG so wanted to make sure I have it all straight before the exam.
Thanks!

[Margaret Frank]

I agree with this question too. I am still quite confused on the horizontal treatment maneuvers (except BBQ roll for canalithiasis / geotropic). I see some resources say Gufani for Geotropic and Appiani for Ageotropic but then when I look them up… it almost seems that the names are interchangeable and the techniques too. Appreciate any feedback with the above question 🙂

[Maika Collins]

It seems likely the test won’t go into treatments for horizontal cupulolithiasis because there isn’t clear evidence per the CPG and the names have been used interchangeably.

Roll Test:
Geotropic —> canalithiasis —> affected side is the one with stronger symptoms / nystagmus —> Treatment: BBQ Roll; 2017 BPPV CPG says “gufoni for geotropic / canalithiasis”

Ageotropic -> cupulolithiasis -> affected side is the one with weaker symptoms / nystagmus -> Treatment: 2017 BPPV CPG says “gufoni for ageotropic / cupulolithiasis”

What I was taught for horizontal cupulolithiasis… Casani; or Gufoni which converts it to canalithiasis which can then be treated with Appiani.

I think because it’s unclear the course group the maneuvers together as “modified libertory”. I could be wrong!

[Kyle Reedy]

I have not taken the NCS so i cannot attest to the questions. However, what i do think is important for this test is that they always want to know application, more so correct application. So i do think it makes sense for them to ask the correct head rotation for tests to ensure you are doing a correct R vs L Gufani. Especially the starting positions.

In practice, i use a gufani instead of a BBQ roll. More so, the gufani can be reverse for a cupulithiasis vs a canalithiasis. An example is how you look at the bow and lean test to diagnose the effected ear for a HoSCC canal/cupulolithiasis.

So application:
If i were to be treat a L horizontal canal canalithiasis. I can treat with a L gufoni. This requires me to to the patient in contralateral sidelying (R), then rotate to the ground (contra rotation) (R), then rise to sitting.
also a tip, a goal for cupulo is to convert it to canal then treat it like a canal.

lastly. gufoni=appiani

[Chrissy Durrough Lugge]

Great discussion, everyone! Yes, there isn’t clear evidence for horizontal cupulolithiasis. I would be surprised if the NCS questions go much beyond treatments for posterior canal. The exam writers only have 200 questions to assess specialization – while anything is fair game, I think they will focus on the most common presentation of this niche topic.
Chrissy

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