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

Abstract

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.

Complex benign horizontal canal positional vertigo: new perceptual management

“…The strategic treatment reported in this series of HSC-BPPV has resulted complete resolution of vertigo over 88% as against 42% in control group 3 , 14 from other studies at 12 weeks. Ramos B.F. 18 reported total resolution of vertigo and positional nystagmus in all seven subjects of geotropic induced nystagmus in a single sitting with Zuma modified maneuver. Results of this series (success rate in 92% canalithiasis and 85% in cupolithiasis) are comparable to study report of A.P.Casani 2 , 6 (success rate 90% in canalolithiasis and 65% in cupololithiasis) and better over the study reports of Apiani 8 and Nuti 3 who used FPP technique and nearly to Epley’s 19 method for PSC-BPPV.…”

Management of Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo

“…Personal experience is really important for defining a strategy to manage these patients. On the basis of our experience, we have adopted the Zuma maneuver and the modified Zuma maneuver for both apogeotropic and geotropic variants of LC-BPPV (50,71). Knowledge of the anatomy and pathophysiologic mechanisms of the semicircular canals is essential for correct management of these patients.…”

“…The head is then turned 90 • toward the unaffected side (step IV). Finally, the patient's head is tilted slightly forward, followed by a slow return to the sitting position (step V) (Figure 8) (71).…”

“…Knowledge of the anatomy and pathophysiological mechanisms of the semicircular canals is essential for the correct diagnosis and treatment of any BPPV. Adhering to the concept that repositioning of otoliths should be performed from the affected side toward the healthy side, similarly to every PC-BPPV maneuver (i.e., Epley and Sémont Maneuvers), we have chosen the modified Zuma maneuver ( 71 ) for treatment of geotropic LC-BPPV. This maneuver was effective for geotropic HC-BPPV after a single application.…”