BackgroundSeveral canalith repositioning Browband Headstall procedures (CRPs) such as Gufoni maneuver have been proposed to treat the apogeotropic lateral semicircular canal variant of BPPV (LC-BPPV).The reported success rate varied widely in different studies.Research showed that there was a risk of treatment failure due to insufficient repositioning of the debris.So far, there is insufficient evidence to recommend a preferable CRP for apogeotropic LC-BPPV.Case descriptionA 49-year-old woman and a 48-year-old man diagnosed with apogeotropic LC-BPPV relapse were treated with original Gufoni maneuver for apogeotropic variant but no satisfactory result was obtained.
A variation of Gufoni maneuver originally proposed for the geotropic variant was applied to detach otoconia toward the utricle or the non-ampullary arm.Apogeotropic nystagmus was successfully transformed into the geotropic variant.The subsequent Gufoni maneuver was successful.On a 64-year-old male with untreated apogeotropic LC-BPPV, we performed the Gufoni maneuver variation and observed a change in nystagmus direction.In all the three cases, no relapse of vertigo was reported after 1 month.
ConclusionThe new application of TV Set Overlay Gufoni maneuver variation may improve the treatment of apogeotropic LC-BPPV.Treatment efficacy and patient-specific optimization such as head rotation angle deserve a large-scale validation and further investigation.