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Treatment of the Horizontal Semicircular Canal Canalithiasis: Pros and Cons of the Repositioning Maneuvers in a Clinical Study and Critical Review of the Literature

Objective: Several repositioning maneuvers have been proposed for the treatment of benign paroxysmal positional vertigo (BPPV) due to canalithiasis of the horizontal semicircular canal (HSC). However, comparisons between these canalith repositioning procedures as well as a generally accepted algorithm for the management of HSC canalithiasis are currently lacking. The aim of this study was to compare the efficacy of 3 different treatment proposals and review the relevant literature. Study Design: Prospective clinical study. Setting: Tertiary neurotology department. Patients: Sixty patients diagnosed with HSC canalithiasis. Interventions: A single application of Baloh's maneuver (n = 13), Vannucchi's forced prolonged position (n = 29), or Asprella-Gufoni maneuver (n = 18). Main Outcome Measures: Bilateral geotropic nystagmus. Results: The first application of the Baloh's maneuver seemed to be significantly less effective than both Vannucchi's forced prolonged position (p = 0.035) and the Asprella-Gufoni maneuver (p = 0.006). No significant difference was detected in the efficiency of Vannucchi's forced prolonged position and the Asprella-Gufoni maneuver for this population (p = 0.4). Conclusion: The Asprella-Gufoni maneuver and Vannucchi's forced prolonged position both seem to be significantly more effective than the Baloh's maneuver in the treatment of HSC canalithiasis. The important pros of the Asprella-Gufoni maneuver versus Vannucchi's forced prolonged position are patient's convenience and maximal use of gravitational and angular acceleration forces. Controlled clinical studies are needed to conclude to an evidence-based proposal for the therapeutical steps that should be followed after the diagnosis of HSC canalithiasis.