Randomized clinical trial for geotropic horizontal canal benign paroxysmal positional vertigo

Objectives: To determine the immediate and long-term therapeutic efficacies of barbecue rotation and Gufoni maneuvers, a randomized, prospective, and sham-controlled study was conducted in patients with the geotropic type of benign paroxysmal positional vertigo involving the horizontal semicircular canal (HC-BPPV). Methods: In 10 nationwide dizziness clinics in Korea, 170 consecutive patients (107 women, age range 11-97 years, mean age±SD 61±15 years, median=61 years) with geotropic HC-BPPV were randomly assigned to barbecue rotation (n = 56), Gufoni (n = 64), or sham maneuver (n = 50). An immediate response was determined within 1 hour after a maximum of 2 trials of each maneuver on the visit day. We also assessed the cumulative results of each maneuver by following up the patients for 1 month. Results: After a maximum of 2 maneuvers on the initial visit day, barbecue rotation (38 of 55 [69.1%]) and Gufoni (39 of 64 [60.9%]) maneuvers showed better responses than the sham maneuver (17 of 48 [35.4%]). The cumulative therapeutic effects were also better with barbecue rotation (p = 0.006) and Gufoni (p = 0.031) maneuvers than with the sham maneuver. However, therapeutic efficacies did not differ between the barbecue rotation and Gufoni groups in terms of both immediate (p = 0.46) and long-term (p = 0.10) outcomes. Conclusion: Using a prospective randomized trial, we demonstrated that barbecue rotation and Gufoni maneuvers are effective in treating geotropic HC-BPPV. Classification of evidence: This study provides Class I evidence that barbecue rotation and Gufoni maneuvers are effective in the treatment of geotropic HC-BPPV.