BPPV - the horizontal spin

Updated: Aug 28, 2018

Dizzy Dialogue

What’s the GO with CupulO??

By Leia Barnes

Advanced Vestibular Physiotherapist

Have you ever asked what’s the g-o with all these horizontal canal BPPV cupulolithiasis options?? With so many Italian names to remember like the Gufoni, Casani, Appiani, Asprella and Vanucchi, it feels easier to just stick with what you know and not venture out….but then you might miss an opportunity for quicker resolution for your patients?

Let’s dig a little deeper to suss it all out…..

Firstly the Gufoni has two main versions Gufoni for Geotropicand Gufoni for Ageotropic. The current focus is on the Ageotropic version.

The confusion starts here: the Gufoni for Ageotropic has been described two different ways in the literature, with the main variation ofhead turn45°downvs head turn 45° up… The only way to know which variation the author is commenting on is to read the description within the article (cruel, I know!)

· The “original” Gufoni Manoeuvre for Ageotropic(head down) was initially proposed by Gufoni in 1998 (Italian paper) and later by Casani [2002, 2011]. Alternative names include “Modified Semont” [Casani 2002] or simply “Casani Manoeuvre”. This version involves sitting on the edge of the bed and rapidly lying to the affected side then quickly turning the patient’s head 45°down towards the bed for 2 mins, then quickly returning to upright. The “original” Gufoni for Ageotropic Horizontal Canal BPPV features in studies by Vannuchi 2005 and Mandala et al. 2013.

· The “new” Gufoni Manoeuvre for Ageotropic(head up) was described by the Appiani research group in 2005 then later in Kim et al. 2012, then Gold et al. [2014] and Kim & Zee [2014]. This version involves lying on the affected side, but pausing for 1-2 min, then quickly moved to head 45°up for 2 min. The patient then returns to upright.

My suggestion is to stick to one name for each version and ALWAYS check the description in any studies you read. For me the “original” is best known as “Casani” and the “new” is now simply “Gufoni for Ageotropic”. This is because more recent publications are also dropping the ‘new’ and simply referencing Appiani 2005. The final question that remains is which one to use and when? That’s a great topic for the next time, the first step is simply knowing ‘who is who, in the zoo!’