New treatment strategy for cupulolithiasis associated with benign paroxysmal positional vertigo of the lateral canal: the head-tilt hopping exercise

Abstract

This study was performed to determine whether a novel treatment was effective against cupulolithiasis associated with benign paroxysmal positional vertigo (BPPV) of the lateral semicircular canal, which is characterized by apogeotropic direction-changing nystagmus. We herein describe our head-tilt hopping (HtH) exercise, which is designed to release otoconial debris strongly adhered to the cupula. The subjects were trained to hop while tilting their heads laterally. They completed 3 to 5 exercise sessions per day over a 4-week period. Each session ended with a 20-hop trial. The HtH exercises were performed by 27 patients with intractable lateral canal BPPV who exhibited positional vertigo and persistent nystagmus beating toward the uppermost ear for more than 4 weeks, despite performing therapeutic head shaking in the horizontal plane maneuver. All the patients were subjected to the supine roll test before and immediately after the first trial as well as after 1 and 4 weeks of the program to evaluate the effect of the treatment on their apogeotropic nystagmus. Nystagmus of 9 (33.3 %) patients disappeared immediately after the first training session. After 1 and 4 weeks of the training, the number of patients that had experienced either of these improvements had increased to 15 (55.6 %) and 19 (70.4 %) subjects, respectively. These results suggest that HtH exercises aimed at releasing otoconial debris from the cupula are feasible as a new therapy for cupulolithiasis associated with intractable lateral canal BPPV. However, further studies for comparison with control are required to confirm these preliminary results.

Apogeotropic Horizontal Canal Benign Paroxysmal Positional Vertigo: Zuma e Maia Maneuver versus Appiani Variant of Gufoni

“…For the treatment of Apo-DCPN BPPV, several maneuvers, including the modified Semont or Asprella, therapeutic headshaking, forced prolonged position, Gufoni, modified Gufoni by Appiani and, lately, the Zuma e Maia maneuver, have been introduced [ 4 , 13 , 14 ]. In 1998, Gufoni described a maneuver for BPPV-HSC as an alternative to the Lempert maneuver in elderly or overweight patients and in those with reduce mobility.…”

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

“…Therefore, the ideal treatment maneuver should be designed considering the possibility of both cases. Until now, several treatment maneuvers have been proposed to treat the HSCC cupulolithiasis regardless of the location where the otolithic debris is attached to the cupula, including a head shaking maneuver in a supine position, a cupulolith repositioning maneuver by mastoid oscillation (CuRM) [ 9 ], head-tilt hopping exercises [ 10 ], and, recently, Zuma’s maneuver [ 11 ]. However, the effectiveness of each treatment method has not been sufficiently verified in a large number of patients, and no standard maneuver has been established.…”

Physical Therapy for the Horizontal Semicircular Cupulolithiasis: A Prospective Interventional Case Series from an Otoneurology Center in South Rajasthan, India

“…29,30 Cupulolithiasis was first reported in 1969 as a granular basophilic mass attached to the cupula of the posterior semicircular canal in the temporal bone histological sections of two patients 31 but a clinico-physiologic basis of its existence in the HSCs generating a long-duration, nearly nonfatigable apogeotropic horizontal PN during SRT was elaborated much later. 6,7,29 In the last decade, seven prospective interventional studies [32][33][34][35][36][37][38] have addressed patients with the apogeotropic variant of HSC-BPPV but only two 34,36 out of these seven include subjects with exclusive HSC-BPPV-cu, while the others 32,33,35,37,38 include those with short anterior arm canalolithiasis as well. Segregation of the cupulolithiasis (Cup-C or Cup-U), and its influence on the treatment of 40 patients with ostensive HSC-BPPV-cu with either one-stage (Cup-U) or two-stage (Cup-C) forced prolonged positioning (FPP) is described by the Chiou et al 32 but the study possibly includes patients with short anterior arm horizontal semicircular canalolithiasis (duration of the apogeotropic horizontal PN and its unchanging character not specified).…”