Apogeotropic variant of horizontal semicircular canal benign paroxysmal positional vertigo: Where are the particles?

Ramos, Bernardo Faria; Cal, Renato Valério Rodrigues; Brock, Camila Martins; Albernaz, Pedro Luiz Mangabeira; Maia, Francisco Zuma e

doi:10.4081/audiores.2019.228

Cited by 18 publications

(22 citation statements)

References 9 publications

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“…Unfortunately, at the present time there are insufficient data to establish the relative efficacy of the FPP versus other maneuvers such as the barbecue maneuver. 19,20 Apart from the GLM, outcomes of most LC-BPPV treatment techniques are based on class IV studies, and the strength of recommendation is not strong. 17 The GLM seems to be slightly more effective in a similar study.…”

Section: Discussionmentioning

confidence: 99%

Double‐Blind Randomized Trial on the Efficacy of the Forced Prolonged Position for Treatment of Lateral Canal Benign Paroxysmal Positional Vertigo

et al. 2020

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Objectives/Hypothesis: The need for class I and II studies on the efficacy of liberatory maneuvers in the treatment of lateral canal benign paroxysmal positional vertigo (LC-BPPV) motivated the present double-blind randomized trial on the short-term efficacy of the forced prolonged position (FPP). Study Design: Double-blind, randomized controlled trial. Methods: Two hundred twenty-one patients with unilateral LC-BPPV met the inclusion criteria for a multicentric study. Patients were randomly assigned to treatment by FPP (116 subjects) or sham treatment (105 subjects). Subjects were followed up at 24 hours with the supine roll test by blinded examiners. Results: Among the sample, 67.4% and 32.6% of the patients showed respectively geotropic and apogeotropic variant of LC-BPPV. At the 24-hour follow-up, the effectiveness of FFP compared to the sham maneuver was, respectively, 57.8% versus 12.4% (P < .0001) in the total sample, 76.9% versus 11.3% (P < .0001) in the geotropic variant group, and 60.5% versus 17.6% (P = .0003) in the apogeotropic variant group, including resolution or transformation to geotropic variant. Conclusions: FPP proved highly effective compared to the sham maneuver. The present class 2 study of the efficacy of the FPP changes the level of recommendation of the method for treating LC-BPPV into a strong one.

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Section: Discussionmentioning

confidence: 99%

Double‐Blind Randomized Trial on the Efficacy of the Forced Prolonged Position for Treatment of Lateral Canal Benign Paroxysmal Positional Vertigo

et al. 2020

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“…Furthermore, we have previously demonstrated the usefulness of observing the pattern of the nystagmus evoked in each step of the Zuma maneuver in patients with apogeotropic LC-BPPV (36). According to the hypothesis presented previously, we can deduce where otoliths are located.…”

Section: Management Of the Apogeotropic Variant Of Lateral Canal Benimentioning

confidence: 82%

“…The geotropic variant is attributed to free floating particles in the posterior arm of the LC. In contrast, the apogeotropic variant of LC-BPPV is attributed to free floating particles in the anterior arm of the LC, particles attached to the cupula facing the canal, or particles attached to the cupula facing the utricle (33)(34)(35)(36).…”

Section: Diagnosis Of Lc-bppvmentioning

confidence: 99%

“…Choosing the correct repositioning procedure for the treatment of LC-BPPV is very complicated, since diagnosis of the affected side and the subtype of the BPPV is critical for successful treatment (43). Apogeotropic LC-BPPV is attributed to particles attached to the cupula facing the canal, particles attached to the cupula facing the utricle, or free-floating particles in the anterior arm of the LC (33)(34)(35)(36). Consequently, the objective of the repositioning maneuver for this variant is to detach the otoliths from the cupula (in patients with cupulolithiasis facing the canal) and remove them and free particles from the anterior arm through the posterior arm toward the utricle.…”

Section: Management Of the Apogeotropic Variant Of Lateral Canal Benimentioning

confidence: 99%

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Management of Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo

et al. 2020

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Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vestibular vertigo. It is caused by free-floating otoconia moving freely in one of the semicircular canals (canalolithiasis) or by otoliths adhered to the cupula (cupulolithiasis). The posterior canal is the most common canal affected, followed by the lateral canal. Diagnosis of the side affected is critical for successful treatment; therefore, suppressing visual fixation is essential to examination of these patients' eye movement. On the basis of our experience, we have adopted the Zuma maneuver and the modified Zuma maneuver for both apogeotropic and geotropic variants of lateral canal BPPV. Knowledge of the anatomy and pathophysiologic mechanisms of the semicircular canals is essential for correct management of these patients. Hence, using a single maneuver and its modification may facilitate daily neurotological practice.

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“…[1][2][3] Different types of reposition maneuvers have been proposed for the management of geotropic and apogeotropic LC-BPPV: Gufoni maneuver, Zuma maneuver, Forced Prolonged Position (Vannucchi Technique) and Barbecue Rotation (Lempert maneuver, Vannucchi-Asprella maneuver). [4][5][6][7][8][9] For practical reasons, since there are several types of reposition maneuvers described for LC-BPPV, it was felt that the Zuma maneuver, with a brief modification (Zuma modified maneuver) could be an alternative treatment for geotropic LC-BPPV.…”

Section: Introductionmentioning

confidence: 99%

Zuma Modified Maneuver as a Treatment to Geotropic Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo

Ramos

Cal

Brock

et al. 2020

Int Arch Otorhinolaryngol

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Introduction Benign Paroxysmal Positional Vertigo (BPPV) is the most common vestibular disorder, resulting from detached otoliths that migrate to one of the semicircular canals – canalolithiasis – or one of the cupulas – cupulolithiasis. The present study is related to lateral canal BPPVs, which may be either geotropic or apogeotropic. The geotropic variant of lateral semicircular canal benign paroxysmal positional vertigo (LC-BPPV) is attributed to free floating particles in the posterior arm of the lateral semicircular canal. Objectives To verify the possibility of employing the Zuma repositioning maneuver, with a brief modification, as an alternative treatment for geotropic LC-BPPV. Methods Seven patients with geotropic LC-BPPV were enrolled and treated with the Zuma modified maneuver. Patients were reevaluated 1 hour after a single maneuver, to confirm the resolution of vertigo and positional nystagmus. Results All seven patients achieved immediate resolution of vertigo and positional nystagmus as measured 1 hour after the application of the maneuver. Conclusion The Zuma modified maneuver was effective for geotropic LC-BPPV after a single application. The use of the Zuma maneuver for both apogeotropic and geotropic LC-BPPV may simplify the treatment of these patients.

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Apogeotropic variant of horizontal semicircular canal benign paroxysmal positional vertigo: Where are the particles?

Cited by 18 publications

References 9 publications

Double‐Blind Randomized Trial on the Efficacy of the Forced Prolonged Position for Treatment of Lateral Canal Benign Paroxysmal Positional Vertigo

Double‐Blind Randomized Trial on the Efficacy of the Forced Prolonged Position for Treatment of Lateral Canal Benign Paroxysmal Positional Vertigo

Management of Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo

Zuma Modified Maneuver as a Treatment to Geotropic Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo

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