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A Liberatory Maneuver for the Treatment of Horizontal Canal Paroxysmal Positional Vertigo

Objective The purpose of this study was to determine the effectiveness of a new liberatory maneuver in the management of the geotropic variant of horizontal canal paroxysmal positional vertigo (HC-PPV). Study Design Case review. Setting Outpatient clinic. Patients The diagnosis of HC-PPV was based on the history of recurrent sudden crisis of vertigo associated with bursts of horizontal geotropic paroxysmal nystagmus provoked by turning the head from the supine to either lateral position. The patients were 11 men and 21 women ranging in age from 30 to 85 years (average 55.43 years), and the average duration of symptoms was 7.68 days. Interventions All patients were treated with a liberatory maneuver based on the hypothesis that the syndrome is caused by the presence of free-floating dense particles inside the endolymph of the posterior arm of the semicircular horizontal canal. The maneuver favors their outmigration into the utricle. Patients were reexamined immediately after the treatment and again 2 days later. Main Outcome Measure The treatment outcome was considered as responsive when, after one or more liberatory maneuvers, the clinical signs of PPV disappeared at the end of physical therapy. Results The liberatory maneuver resulted in a complete remission of the positioning vertigo and nystagmus in all patients after the first session. Conclusions This approach represents a simple and effective approach to the management of the geotropic form of HC-PPV.