Prediction of Successful Repositioning of Horizontal Canal Benign Positional Vertigo in Gufoni's Maneuver: A Preliminary Study

Moon, Jeong Soo; Shin, Jong Wook; Kim, Hyun Jung; Baek, In Chul; Oh, Eung Seok; Oh, Ji Eun; Lee, Kyung Jae; Lee, Ji Hee; Kim, Jae Moon; Jeong, Seong Hae

Abstract

BACKGROUND AND OBJECTIVES
Although several methods of repositioning maneuver have been introduced for the benign paroxysmal positional vertigo involving horizontal canal (HC-BPPV), no study has investigated the nystagmus pattern during the repositioning maneuver and its correlation with the repositioning results. Therefore, we evaluated the predictive value of the nystagmus for successful repositioning by studying the nystagmus pattern during the position of the Gufoni's maneuver.
MATERIALS AND METHODS
Seventeen consecutive patients (age range=36~76 years, median age=64), with a diagnosis of HC-BPPV were recruited between July and August 2010. The Gufoni's maneuver for apogeotropic and geotropic nystagmus was performed. After 30 minutes, the treatment outcome was evaluated according to the nystagmus pattern at the individual stage of Gufoni's maneuver. Successful treatment was defined by the resolution of positional vertigo in geotropic HC-BPPV and nystagmus shifted from apogeotropic to geotropic in apogeotropic HC-BPPV.
RESULTS
In the successfully treated patients, 4 of 6 patients had the contralesional nystagmus between 1st and 2nd position of Gufoni's maneuver. Ipsilesional nystagmus in 1st position of Gufoni's maneuver was observed in 1 patient with apogeotropic nystagmus. And the other 1 patient with Geotropic HC-BPPV showed no nystagmus in 2nd position after contralesional nystagmus in 1st position of Gufoni's maneuver. Unsuccessfully treated 11 patients had a conversion of nystagmus direction in 2nd position after 1st step.
CONCLUSION
During the 2nd position of the Gufoni's maneuver, a nystagmus toward unaffected side predicts a successful repositioning, whereas reversed nystagmus is suggestive of poor response to repositioning.