Immediate and short-term effects of Gufoni and Appiani liberatory maneuver for treatment of ageotropic horizontal canal benign paroxysmal positional vertigo: A prospective randomized trial

Gufoni maneuver for treatment of horizontal canal benign paroxysmal positional vertigo: a systematic review of randomized controlled trials

PURPOSE

This review aims to investigate the effects of the Gufoni maneuver on horizontal semicircular canal benign paroxysmal positional vertigo (HC-BPPV).

METHODS

A comprehensive search, including PubMed, PEDro, REHABDATA, SCOPUS, EMBASE, and Web of Science, was conducted to determine randomized clinical trials (RCTs) studying the effects of the Gufoni maneuver for HC-BPPV from inception to March 1, 2024. The quality of the included studies was estimated using the Physiotherapy Evidence Database (PEDro) scale.

RESULTS

Ten randomized controlled trials (RCTs) were included in this review with a total of 1025 HC-BPPV patients (mean age = 58.58 years; 63% female; 55% right-side HC-HBPPV; 49% geotropic HC-BPPV). The included RCTs ranged from 4 to 9 out of 10 (median = 6.5) on the PEDro scale. The included studies showed that the Gufoni maneuver revealed efficacy when compared to the sham maneuver but not when compared to other maneuvers such as the Barbecue roll maneuver, the Appiani maneuver, the Mastoid oscillation, the head shaking, and the modified Gufoni maneuver.

CONCLUSIONS

The Gufoni maneuver is considered an option for treating patients with geotropic or apogeotropic HC-BPPV. Precise diagnosis of the BPPV, the subtype of HC-BPPV, symptom duration, history of previous BPPV attacks, the applied methods of maneuver and the proficiency of the clinician performing the maneuver, proper diagnosis, presence of any underlying health conditions are critical for successful treatment. Further studies are strongly warranted.

New Therapeutic Maneuver for Horizontal Semicircular Canal Cupulolithiasis: A Prospective Randomized Trial

Background: There are debates on whether mastoid oscillation has any benefit or harm in treating horizontal semicircular canal (HSCC) cupulolithiasis. The goal of this study was to investigate the therapeutic effects of the new maneuver using only inertia and gravity and compare it with the previously reported cupulolith repositioning maneuver using mastoid vibration (CuRM). Methods: We enrolled 57 patients diagnosed with HSCC cupulolithiasis. Patients were randomly allocated to the previously reported CuRM or the new maneuver (briefly, 30° head rotation to the affected side and thereafter bidirectional side-lying) using simply inertia and gravity, and their immediate and short-term effects were evaluated. Results: The immediate success rate did not differ significantly between the CuRM (8 of 22, 36.4%) and the new maneuver (10 of 35, 28.6%) groups (p = 0.538, Pearson’s chi-square test). The late resolution rates at the first follow-up of the CuRM (75%, 9 of 12) and new maneuver groups (82.6%, 19 of 23) were very high, and there was no statistical difference between them (p = 0.670, Fisher’s exact test). Conclusions: This study showed that the new maneuver was effective for treating HSCC cupulolithiasis with an immediate success rate of 28.6% (10 of 35). Although it did not show better results than the existing maneuver using vibration, there was no statistical difference. Considering the debate on the effectiveness of oscillation, we believe our new maneuver is a conservative alternative that uses only inertia and gravity, and it can be easily performed in clinics where oscillation equipment is not available.