Gufoni maneuver

geotropic lateral canal BPPV

The key points regarding the Gufoni maneuver for treating geotropic lateral canal BPPV:

1. The Gufoni maneuver is a reasonable option for treating lateral canal BPPV with geotropic nystagmus.

2. To perform the maneuver correctly, one must determine:

  a) If the nystagmus is geotropic (beating towards the ground) or ageotropic (beating away from the ground)
  b) The side where the debris is located (the "affected" side)

3. For geotropic nystagmus, the affected side is usually the one with stronger nystagmus. The maneuver starts on the unaffected side (side with weaker nystagmus).

4. The Gufoni maneuver for geotropic BPPV involves:

  - Lying on the unaffected side for 2 minutes
  - Turning the head 45° nose down and remaining in this position for 2 minutes  
  - Returning to the upright position
  - Abrupt head movements are suggested

5. The maneuver is essentially half of the "log-roll" maneuver. The "business end" of the log-roll for geotropic BPPV is similar to the last two positions of the Gufoni.

6. The geometric logic of the maneuver is to start with the affected ear up, then move to the affected ear down 45°. This should help move debris out of the lateral canal.

7. Nausea and vomiting are potential issues, as the maneuver requires maintaining positions that induce severe vertigo for several minutes.

8. Resources like the BPPV viewer simulator can help visualize the geometry and mechanics of the maneuver.

In summary, the Gufoni maneuver is a quicker alternative to the full log-roll for geotropic lateral canal BPPV. It relies on correct identification of the nystagmus direction and affected side. While it may be very effective, the positions can provoke strong symptoms, so patients should be prepared for potential discomfort. Understanding the geometric basis of the maneuver using simulation tools may be helpful for practitioners.

Gufoni M, Mastrosimone L, Di F N. Repositioning maneuver in benign paroxysmal vertigo of horizontal semicircular canal[J]. Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale, 1998, 18(6): 363-367.