Canalith Repositioning Maneuvers for Treatment of Apogeotropic Lateral Semicircular Canal BPPV: A Systematic Review

Abstract

Benign Paroxysmal Positional Vertigo is one of the most common causes of peripheral vestibular vertigo. It is can be caused by attachment of otoliths to the cupula (cupulolithiasis) or otoconia freely floating in the semicircular canals (canalolithiasis). It is critical to get a clear diagnosis of the affected side and rule out any BPPV subtypes before starting the treatment. Some researchers converted LC-BPPV from its apogeotropic to geotropic form in most patients, while others have established the efficacy of various procedures (Gufoni, Head Shaking, and Sham) to relieve vertigo and nystagmus. Although various therapeutic maneuvers are available, the question of which maneuver is superior for treating apogeotropic LC-BPPV remains unanswered. This systematic review aimed to evaluate the effectiveness of Gufoni, Head shaking, and Sham maneuvers in alleviating vertigo and nystagmus encountered by individuals with LC-BPPV and comparing these treatment outcomes. The search terms 'BPPV,' 'Lateral canal BPPV,' ''Apogeotropic LC-BPPV,' 'repositioning maneuvers,' 'modified Guffoni maneuver,' 'Sham maneuver,' 'Head shaking Maneuver' were entered into different databases (Google Scholar, Science Direct, and PubMed). The inclusion and exclusion criteria were clearly stated, and only articles fulfilling the criteria were chosen, while others were excluded. The screening of articles was done independently by two reviewers at all stages. The quality analysis was done using the CASP scale on the final selected articles. The database search resulted in 543 articles, of which eight were included at final stage as well as for the qualitative analysis. According to the qualitative analysis, three studies were rated as moderate, and five as strong. All eight studies were characterized as randomized control trials, with a level of evidence of level two. The study features, sample demographic information, diagnosis, and management strategies employed were all derived from the articles. Seven of the included studies utilized Gufoni, three used Head Shaking, and four used Sham. Gufoni had the highest success rate of the three, and these rates were comparable across all investigations. When Head-Shaking was utilized alone, fair results were reported, but when paired with Barbecue, the rates increased. In comparison to the other two, Sham has shown the least effectiveness.