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Immediate efficacy of Gufoni maneuver for horizontal canal benign paroxysmal positional vertigo (HC-BPPV): a meta-analysis
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ANL-2613; No. of Pages 7 Auris Nasus Larynx xxx (2019) xxx–xxx Contents lists available at ScienceDirect
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Immediate efficacy of Gufoni maneuver for horizontal canal benign paroxysmal positional vertigo (HC-BPPV): a meta-analysis Wei Fu a,1, Junliang Han b,1, Ning Chang c,1, Dong Wei b, Ya Bai b, Yuanyuan Wang b, Feng He b, Xiaoming Wang a,* a
Department of Geriatrics, Xijing Hospital, Fourth Military Medical University, No. 15, Changle West Road, Xi’an, Shaanxi 710032, China Department of Neurology, Xijing Hospital, Fourth Military Medical University, No. 15, Changle West Road, Xi’an, Shaanxi 710032, China c Department of Pulmonary Medicine, Xijing Hospital, Fourth Military Medical University, No. 15, Changle West Road, Xi’an, Shaanxi 710032, China b
A R T I C L E I N F O
A B S T R A C T
Article history: Received 28 December 2018 Accepted 12 May 2019 Available online xxx
Objective: This meta-analysis aims to systematically measure the immediate efficacy of the Gufoni maneuver for horizontal canal benign paroxysmal positional vertigo (HC-BPPV). Methods: A extensive search electronic databases, including PubMed, Embase, Web of Science and Cochrane library, were searched until to September 1, 2018 for relevant articles. We selected only randomized clinical trials studying with treatment of HC-BPPV employ by the Gufoni maneuver. Results: Five randomized clinical trials were included in the current meta-analysis with a total of 714 HC-BPPV patients. The meta-analysis revealed that Gufoni maneuver had a higher immediate recovery rate than sham maneuver in treatment of HC-BPPV (risk ratio = 2.68, 95% CI, 1.54–4.65, p < 0.01). No difference was observed in immediate recovery rate between Gufoni maneuver and other maneuvers (risk ratio = 1.18, 95% CI, 0.99–1.41, p = 0.06). And Gufoni maneuver had a similar otolith switch rate with other maneuvers (risk ratio = 2.13, 95% CI, 0.56–8.07, p = 0.27). Conclusion: Gufoni maneuver has a satisfactory immediate efficacy for HC-BPPV and does not increase otolith switch rate. © 2019 Elsevier B.V. All rights reserved.
Keywords: Benign paroxysmal positional vertigo Horizontal canal Gufoni maneuver Meta-analysis
1. Introduction Benign paroxysmal positional vertigo(BPPV) is the common cause of vertigo. The most common kind of BPPV involves the posterior semicircular canal (PC-BPPV) while the horizontal semicircular canal (HC-BPPV) is involved in a percentage that
* Corresponding author. E-mail addresses: [email protected] (W. Fu), [email protected] (J. Han), [email protected] (N. Chang), [email protected] (D. Wei), [email protected] (Y. Bai), [email protected] (Y. Wang), [email protected] (F. He), [email protected] (X. Wang). 1 These authors have contributed equally to this work.
varies between 10% and 30% [1–3]. HC-BPPV is usually diagnosed by means of the head-roll test, in which the head is turned approximately 90 to the left and to the right with the patient lying supine. Two types of horizontal nystagmus occur—one in which the nystagmus is geotropic (toward the ground in both direction) and the nystagmus is more intense with the head turned to the affected side. Another nystagmus is apogeotropic (toward the ceiling in both direction) and the nystagmus is more intense with the head turned to the unaffected side. Geotropic nystagmus is caused by otoconia situated in the posterior segment of the horizontal canal (canalolithiasis), whereas apogeotropic nystagmus is caused by otoconia situated in the anterior segment of the horizontal canal
https://doi.org/10.1016/j.anl.2019.05.002 0385-8146/© 2019 Elsevier B.V. All rights reserved.
Please cite this article in press as: Fu W, et al. Immediate efficacy of Gufoni maneuver for horizontal canal benign paroxysmal positional vertigo (HC-BPPV): a meta-analysis. Auris Nasus Larynx (2019), https://doi.org/10.1016/j.anl.2019.05.002
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(canalolithiasis), closer to the cupula, possibly attached to it (cupulolithiasis) [4]. Treatment of HC-BPPV relies on some physical maneuvers. Many physical treatments include the barbecue rotation (the patient’s head is rotated in three 90-degree increments, for a total of 270 , from affected ear down, to supine, to unaffected ear down, to prone) [5], Vannucchi’s forced prolonged position (the patient lies with the unaffected ear down for approximately 12 h) [6], head-shaking in the horizontal plane (the patient’s head is shaken from side to side at approximately two cycles per second for 15 s) [7], mastoid oscillation(it was applied on the suprameatal triangle in the posterior superior area of the lesion side auricle with a 60-Hz hand-held vibrator for 30 s) [8] and Gufoni methods have been proposed [9]. The Gufoni maneuver was first described by Gufoni in 1998 [9]. And Gufoni maneuver can treat patients with either a geotropic nystagmus or apogeotropic nystagmus [10]. In geotropic HC-BPPV, the patient quickly lies down on the side of the unaffected ear and remains in this position for 1–2 min, until the evoked nystagmus subsides. The head is then quickly rotated 45 toward the floor and kept in this position for another 2 min, after which the patient resumes an upright position. In apogeotropic HC-BPPV, Gufoni maneuver entails rapid positioning of the patient starting from the sitting position onto the lesion side and remains in this position for 1–2 min, until the evoked nystagmus subsides, then quickly turning the patient’s head 45 upwards and kept in this position for another 2 min, after which the patient resumes an upright position [10]. In previous report, some studies found that Gufoni maneuver is effective in treating patients suffering from HC-BPPV. The variability concerning the resolution rates of HC-BPPV in previous studies may be due to the differences in the follow-up time [11,12]. Recent studies have reported high rates of spontaneous resolution in BPPV. And spontaneous resolution occurs faster in HC-BPPV compared to that of PC-BPPV [13]. Therefore, to minimize the confounding effect of spontaneous remission and to highlight the effects of Gufoni maneuver, this meta-analysis aims to systematically measure the immediate efficacy (within 24 h) of the Gufoni maneuver for HC-BPPV.
Gufoni maneuver; (2) studies have a explicit outcome, such as immediate recovery rate (within 24 h), otolith switch rate. The exclusion criteria were as follows: (1) the study was a review, a letter, or an abstract from a meeting; (2) the outcomes were unavailable or insufficient. 2.3. Data extraction During the selection process, the titles and abstracts of the obtained articles were independently evaluated by two researchers. Disagreements were resolved by discussion. In cases where there was no consensus, a third researcher was asked to make the final decision. Data were analyzed from acquired articles. In addition to the outcome data, we also obtained the names of the authors, study type, country, participants, diagnosis criteria, treatment groups, number of subjects in each group, duration of follow-up. The quality of the selected studies was assessed using the Cochrane evaluation system. 2.4. Statistical analysis The pooled risk ratio (RR) were used to estimate overall therapeutic performance, with corresponding 95% confidential interval (CI). The statistical heterogeneity between studies was tested using the Cochran’s Q test and inconsistency was tested using the I2 test. When p < 0.05 or I2 > 50%, it indicated a significant heterogeneity and a randomized-effects model was selected; otherwise, a fixed-effects model was used. When necessary, study characteristics considered potential sources of heterogeneity were included in a subgroup analysis. Furthermore, in the case of heterogeneity, studies were removed, one by one, to investigate whether that particular study was the source of heterogeneity. All analyses were performed using RevMan 5.3 software (Cochrane Collaboration). 3. Results 3.1. Included studies
2. Materials and methods 2.1. Search strategy A systematic electronic search, including PubMed, Embase, Web of Science and Cochrane library, were searched until to September 1, 2018 for relevant articles. We selected only randomized clinical trials (RCTs) studying with treatment of HC-BPPV employ by the Gufoni maneuver. The search strategies were (“Gufoni maneuver” OR “Gufoni liberatory maneuver”) AND (“benign positional vertigo” OR “benign paroxysmal positional vertigo” OR “BPPV”). Two researchers worked independently to identify all the relevant studies based on the titles and abstracts. 2.2. Inclusion and exclusion criteria Studies were selected based on the following inclusion criteria: (1) studies were RCTs for HC-BPPV treatment with
A total of 66 articles were obtained by searching electronic databases. 23 articles remained after removal of duplicates. After title and abstract were read, 11 articles remained and 12 articles were excluded. After further screened through full text reading, 5 articles were selected in the current metaanalysis. The flow diagram that illustrates study search and selection is shown in Fig. 1. The characteristics of the included studies are given in Table 1 [14–18]. All the selected studies were RCTs, four of which were double-blind RCTs. A total of 714 patients were included. 3.2. Quality assessment According to the Cochrane evaluation system, one study properly assessed all 7 items: random sequence generation (selection bias), allocation concealment (selection bias), blinding of participants and personnel (performance bias), blinding of outcome assessment (detection bias), incomplete
Please cite this article in press as: Fu W, et al. Immediate efficacy of Gufoni maneuver for horizontal canal benign paroxysmal positional vertigo (HC-BPPV): a meta-analysis. Auris Nasus Larynx (2019), https://doi.org/10.1016/j.anl.2019.05.002
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3.3. The immediate efficacy of Gufoni maneuver compared with sham and other maneuvers Five articles assessed the immediate recovery rate, the follow-up time varied from 30 min to 24 h after initial maneuver (30 min to 1 h was described in four studies; 24 h was described in one studie). The result revealed that Gufoni maneuver had a higher immediate recovery rate than sham maneuver in treatment of HC-BPPV (RR = 2.68, 95% CI, 1.54–4.65, p < 0.01, Fig. 3(1.1.1)). However, no difference was observed in immediate recovery rate between Gufoni maneuver and other maneuvers (barbecue, barbecue + FPP, mastoid oscillation and head-shaking) (RR = 1.18, 95% CI, 0.99–1.41, p = 0.06, Fig. 3 (1.1.2)). Furthermore, two subgroups were stratified based on different type of HC-BPPV, in geotropic nystagmus type of HC-BPPV, subgroup analyses showed that the respective pooled RR were 3.58 (95% CI, 0.89–14.37, p = 0.07, Gufoni vs. sham, Fig. 4(1.2.1)) and 1.19 (95% CI, 0.80–1.76, p = 0.40, Gufoni vs. Other maneuvers, Fig. 4(1.2.2)). In apogeotropic nystagmus type of HC-BPPV, subgroup analyses showed that the respective pooled RR were 2.48 (95% CI, 1.55–3.96, p < 0.01, Gufoni vs. sham, Fig. 5(2.2.1)) and 1.16 (95% CI, 0.83–1.62, p = 0.38, Gufoni vs. Other maneuvers, Fig. 5(2.2.2)). 3.4. Otolith switch of the Gufoni maneuvers Freely mobile otoconia moving within the lumen of one semicircular canal can be moved during the course of maneuver treatment. The otolith switch can occur from the horizontal canal to the non-horizontal canal. In this meta-analysis, all 3 studies described the otolith switch during the course of Gufoni maneuver treatment. The results showed that Gufoni maneuver had a similar otolith switch rate with other maneuvers (RR = 2.13, 95% CI, 0.56–8.07, p = 0.27, Fig. 6).
Fig. 1. Flowchart for the selection procedure for studies.
outcome data (attrition bias), selective reporting (reporting bias) and other bias. There are three levels of risk assessment: low risk of bias, unclear risk of bias and high risk of bias. The flow diagram that illustrates quality assessment of the selected studies is shown in Fig. 2.
4. Discussion Gufoni maneuver is simple to perform. There are not many movements to execute, it needs low time of positioning, and positions are comfortable to the patient, making it more readily
Table 1 Characteristics of included studies. Study
Study type
Country
Participants
Diagnosis criteria
Treatment
N
Follow-up
Casani et al. [14]
RCT
Italy
HC-BPPV
Roll test
Gufoni Barbecue + FPP
58 54
24 h
Kim et al. [15]
DB-RCT
Korea
AHC-BPPV
Roll test/lying-down
Gufoni Sham Head-shaking
52 49 53
30 min to 1 h
Kim et al. [16]
DB-RCT
Korea
HC-BPPV
Roll test/lying-down
DB-RCT
Italy
HC/AHC-BPPV
Roll test
64 48 55 27/10 26/9
30 min to 1 h
Mandala et al. [17]
Gufoni Sham Barbecue Gufoni Sham
Kim et al. [18]
DB-RCT
Korea
AHC-BPPV
Roll test/lying-down
Gufoni Sham Mastoid oscillation
70 72 67
30 min to 1 h
1h
Abbreviations: RCT, randomized controlled trail; DB, double blind; FPP, forced prolonged position; HC-BPPV, horizontal canal benign paroxysmal positional vertigo with geotropic nystagmus; AHC-BPPV, horizontal canal benign paroxysmal positional vertigo with apogeotropic nystagmus.
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Fig. 2. Quality assessment of the selected studies.
acceptable [11]. And some studies reported that Gufoni maneuver is effective in treating patients suffering from HCBPPV. Vannucchi et al. reported that there is a success rate of 92% for geotropic HC-BPPV and 77% for apogeotropic HCBPPV [12]. After treatment with Gufoni maneuver in 58 geotropic HC-BPPV patients, Riggio et al. reported the success rate of 79.3% [11]. There are some reasons to explain different success rate. Firstly, HC-BPPV with apogeotropic nystagmus is more difficult to treat than that with geotropic nystagmus. Secondly, it is accepted that BPPV is spontaneously resolved. As time going, the possibility of spontaneous remission will be higher. Besides, HC-BPPV resolved significantly faster than PC-BPPV [13]. Therefore, to minimize the confounding effect of spontaneous remission and to highlight the effects of Gufoni maneuver, in this meta-analysis, we decided to evaluate immediate efficacy of short-term follow-up. Through the systematic search, the meta-analysis included 5 RCT studies to assess the immediate efficacy of Gufoni maneuver for HC-BPPV. According to different maneuvers, 5 RCT studies divided into two subgroups. A total of 427 cases (Gufoni: 223, sham: 204) were included in four studies that were about the comparison between Gufoni maneuver and sham. And we found that the Gufoni maneuver is more effective for treatment of HC-BPPV in comparison to sham. A previously systematic review revealed the similar
result [19]. However, it only included geotropic HC-BPPV. In our result, subgroup analyses showed that Gufoni maneuver had a higher immediate recovery rate than sham maneuver in treatment of apogeotropic nystagmus type of HC-BPPV. Besides, the sources of heterogeneity (I2 = 56%) were analyzed. And we found that the Mandala et al. study is the main source of heterogeneity. If we remove the Mandala et al. study, the heterogeneity will be reduced (I2 = 0%). It has some reasons to explain. Firstly, the sample size was relatively small in Mandala et al. study. Secondly, in Mandala et al. study, the effective treatment outcomes were based on most patients with geotropic nystagmus. Therefore, Gufoni maneuver has high success rate. Furthermore, the immediate efficacy between Gufoni maneuver and other maneuvers (barbecue, barbecue + FPP, mastoid oscillation and head-shaking) were compared in 473 cases in four studies (Gufoni: 244; other maneuvers: 229). And we found that immediate recovery rate did not differ between the Gufoni maneuver and other maneuvers. Subgroup analyses also showed that Gufoni maneuver treatment had similar immediate recovery rate with other maneuver treatments in HC-BPPV with geotropic and apogeotropic nystagmus. Some studies revealed the mechanism of different maneuver methods. It maybe explain the reason why there was no difference of the treatment between Gufoni maneuver and other maneuvers. The Gufoni maneuver remove otolithic
Please cite this article in press as: Fu W, et al. Immediate efficacy of Gufoni maneuver for horizontal canal benign paroxysmal positional vertigo (HC-BPPV): a meta-analysis. Auris Nasus Larynx (2019), https://doi.org/10.1016/j.anl.2019.05.002
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Fig. 3. Forest plot of the immediate recovery rate of Gufoni maneuver. (1.1.1) Comparison of the immediate recovery rate between the Gufoni maneuver and sham; (1.1.2) comparison of the immediate recovery rate between the Gufoni maneuver and other maneuvers (barbecue, barbecue + FPP, mastoid oscillation and headshaking).
Fig. 4. Forest plot of the immediate recovery rate of Gufoni maneuver in HC-BPPV with geotropic nystagmus. (1.2.1) Comparison of the immediate recovery rate between the Gufoni maneuver and sham; (1.1.2) comparison of the immediate recovery rate between the Gufoni maneuver and other maneuvers.
debris by the centrifugal force created by rapid deceleration and gravitation [11]. And barbecue rotation maneuver is based on the principle of exerting an ampullofugal shift of the otolithic debris toward the canal opening to the utricle during quick head rotations in the opposite direction of the pathologic ear [20]. Both Gufoni maneuver and barbecue rotation maneuver have been reported to be effective in treating HC-BPPV (with success rates of 63% vs. 78%) [20,21]. In addition, headshaking maneuver used for treating apogeotropic HC-BPPV. It may cause accelerating decelerating power to detach the otoliths from the cupula, or to migrate the particles toward the posterior part of the horizontal semicircular canal and the debris were removed from the horizontal semicircular canal into the utricle [6,7]. Randomized controlled studies have proven that
the head-shaking maneuver has similar therapeutic efficacy as the Gufoni maneuver in treating apogeotropic HC-BPPV [15]. Mastoid oscillation is another method that causes otolith detachment for the treatment of HC-BPPV and is an effective method for treating apogeotropic HC-BPPV [8,18,22]. Another treatment, called Vannucchi’s forced prolonged position (FPP), involves having the patient lie with the unaffected ear down for approximately 12 h [6]. FPP allows the material in the nonampullar branch of the horizontal semicircular canal to gradually leave the canal and move towards the vestibule under the force of gravity [6]. The current evident result is that the success rate of the Gufoni maneuver is higher than that of Barbecue + FPP maneuver at the 24 h follow-up (86 vs. 61%) [14]. However, the two maneuvers are similar efficacious at the
Please cite this article in press as: Fu W, et al. Immediate efficacy of Gufoni maneuver for horizontal canal benign paroxysmal positional vertigo (HC-BPPV): a meta-analysis. Auris Nasus Larynx (2019), https://doi.org/10.1016/j.anl.2019.05.002
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Fig. 5. Forest plot of the immediate recovery rate of Gufoni maneuver in HC-BPPV with apogeotropic nystagmus. (2.2.1) Comparison of the immediate recovery rate between the Gufoni maneuver and sham; (2.2.2) comparison of the immediate recovery rate between the Gufoni maneuver and other maneuvers.
Fig. 6. Forest plot of the comparison of otolith switch rate between the Gufoni maneuver and other maneuvers.
30th day. The author speculated that it relate to spontaneous remission phenomenon of HC-BPPV. Furthermore, the higher success rate with the Gufoni maneuver at the 24 h follow-up may explain why we observed significant heterogeneity in the Gufoni maneuver and other maneuvers on the evaluation of immediate recovery rate. Transformation of HC-BPPV into another type of BPPV can be occurred during the course of maneuver treatment [23]. The common canal transition is from the horizontal canal to the nonhorizontal canal. A total of 332 cases (Gufoni: 174, control: 158) were included in 3 studies. Overall, transition into nonhorizontal canal was observed in 10 patients and all of them showed a transition into posterior canal benign paroxysmal positional vertigo(PC-BPPV). In this meta-analysis, we found that Gufoni maneuver did not show any difference on ratio of otolith switch, as compared with the other treatment maneuvers. If otolith switch happen into PC-BPPV, all patients can be treated with the Epley or Semont maneuver. The meta-analysis conclude the evidence for a significant positive immediate efficacy of the Gufoni maneuver to treat patients with HC-BPPV. The maneuver is easy to perform and particularly suitable for older, immobile, and obese patients [11]. However, there existed several limitations. First, there are insufficient randomized clinical trials studying with Gufoni maneuver treatment of HC-BPPV. More clinical randomized clinical trials with a larger sample size are required to confirm
these results. Second, we only evaluate the immediate efficacy of the Gufoni maneuver for HC-BPPV. To avoid possible bias from the spontaneous remission which is known to be more frequent in HC-BPPV, we determined the immediate efficacy by reassessing the patients 30 min to 24 h after the physical maneuvers. Because the natural history of HC-BPPV is usually benign, with 36–88% of cases that resolve spontaneously within several days to months [13,24]. Thus, further researches need to apply the appropriate method to evaluate the long-term efficacy of the Gufoni maneuver for HC-BPPV. 5. Conclusion Gufoni maneuver has a satisfactory immediate efficacy for HC-BPPV and does not increase otolith switch rate. References [1] Nuti D, Mandala M, Salerni L. Lateral canal paroxysmal positional vertigo revisited. Ann N Y Acad Sci 2009;1164:316–23. [2] De la Meilleure G, Dehaene I, Depondt M, Damman W, Crevits L, Vanhooren G, et al. Benign paroxysmal positional vertigo of the horizontal canal. J Neurol Neurosurg Psychiatry 1996;60(1):68–71. [3] White JA, Coale KD, Catalano PJ, Oas JG. Diagnosis and management of lateral semicircular canal benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 2005;133(2):278–84. [4] Nuti D, Masini M, Mandala M. Benign paroxysmal positional vertigo and its variants. Handb Clin Neurol 2016;137:241–56.
Please cite this article in press as: Fu W, et al. Immediate efficacy of Gufoni maneuver for horizontal canal benign paroxysmal positional vertigo (HC-BPPV): a meta-analysis. Auris Nasus Larynx (2019), https://doi.org/10.1016/j.anl.2019.05.002
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ANL-2613; No. of Pages 7 W. Fu et al. / Auris Nasus Larynx xxx (2019) xxx–xxx [5] Lempert T. Horizontal benign positional vertigo. Neurology 1994;44 (11):2213–4. [6] Vannucchi P, Giannoni B, Pagnini P. Treatment of horizontal semicircular canal benign paroxysmal positional vertigo. J Vestib Res 1997;7(1):1–6. [7] Oh SY, Kim JS, Jeong SH, Oh YM, Choi KD, Kim BK, et al. Treatment of apogeotropic benign positional vertigo: comparison of therapeutic head-shaking and modified Semont maneuver. J Neurol 2009;256 (8):1330–6. [8] Kim SH, Jo SW, Chung WK, Byeon HK, Lee WS. A cupulolith repositioning maneuver in the treatment of horizontal canal cupulolithiasis. Auris Nasus Larynx 2012;39(2):163–8. [9] Gufoni M, Mastrosimone L, Di NF. Repositioning maneuver in benign paroxysmal vertigo of horizontal semicircular canal. Acta Otorhinolaryngol Ital 1998;18(6):363–7. [10] Kim JS, Zee DS. Clinical practice: benign paroxysmal positional vertigo. N Engl J Med 2014;370(12):1138–47. [11] Riggio F, Dispenza F, Gallina S, Kulamarva G, Gargano R, Speciale R. Management of benign paroxysmal positional vertigo of lateral semicircular canal by Gufoni’s manoeuvre. Am J Otolaryngol 2009;30(2):106–11. [12] Vannucchi P, Asprella Libonati G, Gufoni M. The physical treatment of lateral semicircular canal canalolithiasis. Audiological Med 2005;23 (3):52–6. [13] Imai T, Ito M, Takeda N, Uno A, Matsunaga T, Sekine K, et al. Natural course of the remission of vertigo in patients with benign paroxysmal positional vertigo. Neurology 2005;64(5):920–1. [14] Casani AP, Nacci A, Dallan I, Panicucci E, Gufoni M, Sellari-Franceschini S. Horizontal semicircular canal benign paroxysmal positional vertigo: effectiveness of two different methods of treatment. Audiol Neurootol 2011;16(3):175–84. [15] Kim JS, Oh SY, Lee SH, Kang JH, Kim DU, Jeong SH, et al. Randomized clinical trial for apogeotropic horizontal canal benign paroxysmal positional vertigo. Neurology 2012;78(3):159–66.
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[16] Kim JS, Oh SY, Lee SH, Kang JH, Kim DU, Jeong SH, et al. Randomized clinical trial for geotropic horizontal canal benign paroxysmal positional vertigo. Neurology 2012;79(7):700–7. [17] Mandala M, Pepponi E, Santoro GP, Cambi J, Casani A, Faralli M, et al. Double-blind randomized trial on the efficacy of the Gufoni maneuver for treatment of lateral canal BPPV. Laryngoscope 2013;123 (7):1782–6. [18] Kim HA, Park SW, Kim J, Kang BG, Lee J, Han BI, et al. Efficacy of mastoid oscillation and the Gufoni maneuver for treating apogeotropic horizontal benign positional vertigo: a randomized controlled study. J Neurol 2017;264(5):848–55. [19] van den Broek EM, van der Zaag-Loonen HJ, Bruintjes TD. Systematic review: efficacy of Gufoni maneuver for treatment of lateral canal benign paroxysmal positional vertigo with geotropic nystagmus. Otolaryngol Head Neck Surg 2014;150(6):933–8. [20] Nuti D, Agus G, Barbieri MT, Passali D. The management of horizontal-canal paroxysmal positional vertigo. Acta Otolaryngol 1998;118 (4):455–60. [21] Fife TD, Iverson DJ, Lempert T, Furman JM, Baloh RW, Tusa RJ, et al. Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2008;70 (22):2067–74. [22] Froehling DA, Bowen JM, Mohr DN, Brey RH, Beatty CW, Wollan PC, et al. The canalith repositioning procedure for the treatment of benign paroxysmal positional vertigo: a randomized controlled trial. Mayo Clin Proc 2000;75(7):695–700. [23] Fife TD. Positional dizziness. Continuum (Minneap Minn) 2012;18 (5 Neuro-otology):1060–85. [24] Imai T, Takeda N, Ito M, Inohara H. Natural course of positional vertigo in patients with apogeotropic variant of horizontal canal benign paroxysmal positional vertigo. Auris Nasus Larynx 2011;38(1):2–5.
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Immediate efficacy of Gufoni maneuver for horizontal canal benign paroxysmal positional vertigo (HC-BPPV): a meta-analysis Wei Fu a,1, Junliang Han b,1, Ning Chang c,1, Dong Wei b, Ya Bai b, Yuanyuan Wang b, Feng He b, Xiaoming Wang a,* a
Department of Geriatrics, Xijing Hospital, Fourth Military Medical University, No. 15, Changle West Road, Xi’an, Shaanxi 710032, China Department of Neurology, Xijing Hospital, Fourth Military Medical University, No. 15, Changle West Road, Xi’an, Shaanxi 710032, China c Department of Pulmonary Medicine, Xijing Hospital, Fourth Military Medical University, No. 15, Changle West Road, Xi’an, Shaanxi 710032, China b
A R T I C L E I N F O
A B S T R A C T
Article history: Received 28 December 2018 Accepted 12 May 2019 Available online xxx
Objective: This meta-analysis aims to systematically measure the immediate efficacy of the Gufoni maneuver for horizontal canal benign paroxysmal positional vertigo (HC-BPPV). Methods: A extensive search electronic databases, including PubMed, Embase, Web of Science and Cochrane library, were searched until to September 1, 2018 for relevant articles. We selected only randomized clinical trials studying with treatment of HC-BPPV employ by the Gufoni maneuver. Results: Five randomized clinical trials were included in the current meta-analysis with a total of 714 HC-BPPV patients. The meta-analysis revealed that Gufoni maneuver had a higher immediate recovery rate than sham maneuver in treatment of HC-BPPV (risk ratio = 2.68, 95% CI, 1.54–4.65, p < 0.01). No difference was observed in immediate recovery rate between Gufoni maneuver and other maneuvers (risk ratio = 1.18, 95% CI, 0.99–1.41, p = 0.06). And Gufoni maneuver had a similar otolith switch rate with other maneuvers (risk ratio = 2.13, 95% CI, 0.56–8.07, p = 0.27). Conclusion: Gufoni maneuver has a satisfactory immediate efficacy for HC-BPPV and does not increase otolith switch rate. © 2019 Elsevier B.V. All rights reserved.
Keywords: Benign paroxysmal positional vertigo Horizontal canal Gufoni maneuver Meta-analysis
1. Introduction Benign paroxysmal positional vertigo(BPPV) is the common cause of vertigo. The most common kind of BPPV involves the posterior semicircular canal (PC-BPPV) while the horizontal semicircular canal (HC-BPPV) is involved in a percentage that
* Corresponding author. E-mail addresses: [email protected] (W. Fu), [email protected] (J. Han), [email protected] (N. Chang), [email protected] (D. Wei), [email protected] (Y. Bai), [email protected] (Y. Wang), [email protected] (F. He), [email protected] (X. Wang). 1 These authors have contributed equally to this work.
varies between 10% and 30% [1–3]. HC-BPPV is usually diagnosed by means of the head-roll test, in which the head is turned approximately 90 to the left and to the right with the patient lying supine. Two types of horizontal nystagmus occur—one in which the nystagmus is geotropic (toward the ground in both direction) and the nystagmus is more intense with the head turned to the affected side. Another nystagmus is apogeotropic (toward the ceiling in both direction) and the nystagmus is more intense with the head turned to the unaffected side. Geotropic nystagmus is caused by otoconia situated in the posterior segment of the horizontal canal (canalolithiasis), whereas apogeotropic nystagmus is caused by otoconia situated in the anterior segment of the horizontal canal
https://doi.org/10.1016/j.anl.2019.05.002 0385-8146/© 2019 Elsevier B.V. All rights reserved.
Please cite this article in press as: Fu W, et al. Immediate efficacy of Gufoni maneuver for horizontal canal benign paroxysmal positional vertigo (HC-BPPV): a meta-analysis. Auris Nasus Larynx (2019), https://doi.org/10.1016/j.anl.2019.05.002
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(canalolithiasis), closer to the cupula, possibly attached to it (cupulolithiasis) [4]. Treatment of HC-BPPV relies on some physical maneuvers. Many physical treatments include the barbecue rotation (the patient’s head is rotated in three 90-degree increments, for a total of 270 , from affected ear down, to supine, to unaffected ear down, to prone) [5], Vannucchi’s forced prolonged position (the patient lies with the unaffected ear down for approximately 12 h) [6], head-shaking in the horizontal plane (the patient’s head is shaken from side to side at approximately two cycles per second for 15 s) [7], mastoid oscillation(it was applied on the suprameatal triangle in the posterior superior area of the lesion side auricle with a 60-Hz hand-held vibrator for 30 s) [8] and Gufoni methods have been proposed [9]. The Gufoni maneuver was first described by Gufoni in 1998 [9]. And Gufoni maneuver can treat patients with either a geotropic nystagmus or apogeotropic nystagmus [10]. In geotropic HC-BPPV, the patient quickly lies down on the side of the unaffected ear and remains in this position for 1–2 min, until the evoked nystagmus subsides. The head is then quickly rotated 45 toward the floor and kept in this position for another 2 min, after which the patient resumes an upright position. In apogeotropic HC-BPPV, Gufoni maneuver entails rapid positioning of the patient starting from the sitting position onto the lesion side and remains in this position for 1–2 min, until the evoked nystagmus subsides, then quickly turning the patient’s head 45 upwards and kept in this position for another 2 min, after which the patient resumes an upright position [10]. In previous report, some studies found that Gufoni maneuver is effective in treating patients suffering from HC-BPPV. The variability concerning the resolution rates of HC-BPPV in previous studies may be due to the differences in the follow-up time [11,12]. Recent studies have reported high rates of spontaneous resolution in BPPV. And spontaneous resolution occurs faster in HC-BPPV compared to that of PC-BPPV [13]. Therefore, to minimize the confounding effect of spontaneous remission and to highlight the effects of Gufoni maneuver, this meta-analysis aims to systematically measure the immediate efficacy (within 24 h) of the Gufoni maneuver for HC-BPPV.
Gufoni maneuver; (2) studies have a explicit outcome, such as immediate recovery rate (within 24 h), otolith switch rate. The exclusion criteria were as follows: (1) the study was a review, a letter, or an abstract from a meeting; (2) the outcomes were unavailable or insufficient. 2.3. Data extraction During the selection process, the titles and abstracts of the obtained articles were independently evaluated by two researchers. Disagreements were resolved by discussion. In cases where there was no consensus, a third researcher was asked to make the final decision. Data were analyzed from acquired articles. In addition to the outcome data, we also obtained the names of the authors, study type, country, participants, diagnosis criteria, treatment groups, number of subjects in each group, duration of follow-up. The quality of the selected studies was assessed using the Cochrane evaluation system. 2.4. Statistical analysis The pooled risk ratio (RR) were used to estimate overall therapeutic performance, with corresponding 95% confidential interval (CI). The statistical heterogeneity between studies was tested using the Cochran’s Q test and inconsistency was tested using the I2 test. When p < 0.05 or I2 > 50%, it indicated a significant heterogeneity and a randomized-effects model was selected; otherwise, a fixed-effects model was used. When necessary, study characteristics considered potential sources of heterogeneity were included in a subgroup analysis. Furthermore, in the case of heterogeneity, studies were removed, one by one, to investigate whether that particular study was the source of heterogeneity. All analyses were performed using RevMan 5.3 software (Cochrane Collaboration). 3. Results 3.1. Included studies
2. Materials and methods 2.1. Search strategy A systematic electronic search, including PubMed, Embase, Web of Science and Cochrane library, were searched until to September 1, 2018 for relevant articles. We selected only randomized clinical trials (RCTs) studying with treatment of HC-BPPV employ by the Gufoni maneuver. The search strategies were (“Gufoni maneuver” OR “Gufoni liberatory maneuver”) AND (“benign positional vertigo” OR “benign paroxysmal positional vertigo” OR “BPPV”). Two researchers worked independently to identify all the relevant studies based on the titles and abstracts. 2.2. Inclusion and exclusion criteria Studies were selected based on the following inclusion criteria: (1) studies were RCTs for HC-BPPV treatment with
A total of 66 articles were obtained by searching electronic databases. 23 articles remained after removal of duplicates. After title and abstract were read, 11 articles remained and 12 articles were excluded. After further screened through full text reading, 5 articles were selected in the current metaanalysis. The flow diagram that illustrates study search and selection is shown in Fig. 1. The characteristics of the included studies are given in Table 1 [14–18]. All the selected studies were RCTs, four of which were double-blind RCTs. A total of 714 patients were included. 3.2. Quality assessment According to the Cochrane evaluation system, one study properly assessed all 7 items: random sequence generation (selection bias), allocation concealment (selection bias), blinding of participants and personnel (performance bias), blinding of outcome assessment (detection bias), incomplete
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3.3. The immediate efficacy of Gufoni maneuver compared with sham and other maneuvers Five articles assessed the immediate recovery rate, the follow-up time varied from 30 min to 24 h after initial maneuver (30 min to 1 h was described in four studies; 24 h was described in one studie). The result revealed that Gufoni maneuver had a higher immediate recovery rate than sham maneuver in treatment of HC-BPPV (RR = 2.68, 95% CI, 1.54–4.65, p < 0.01, Fig. 3(1.1.1)). However, no difference was observed in immediate recovery rate between Gufoni maneuver and other maneuvers (barbecue, barbecue + FPP, mastoid oscillation and head-shaking) (RR = 1.18, 95% CI, 0.99–1.41, p = 0.06, Fig. 3 (1.1.2)). Furthermore, two subgroups were stratified based on different type of HC-BPPV, in geotropic nystagmus type of HC-BPPV, subgroup analyses showed that the respective pooled RR were 3.58 (95% CI, 0.89–14.37, p = 0.07, Gufoni vs. sham, Fig. 4(1.2.1)) and 1.19 (95% CI, 0.80–1.76, p = 0.40, Gufoni vs. Other maneuvers, Fig. 4(1.2.2)). In apogeotropic nystagmus type of HC-BPPV, subgroup analyses showed that the respective pooled RR were 2.48 (95% CI, 1.55–3.96, p < 0.01, Gufoni vs. sham, Fig. 5(2.2.1)) and 1.16 (95% CI, 0.83–1.62, p = 0.38, Gufoni vs. Other maneuvers, Fig. 5(2.2.2)). 3.4. Otolith switch of the Gufoni maneuvers Freely mobile otoconia moving within the lumen of one semicircular canal can be moved during the course of maneuver treatment. The otolith switch can occur from the horizontal canal to the non-horizontal canal. In this meta-analysis, all 3 studies described the otolith switch during the course of Gufoni maneuver treatment. The results showed that Gufoni maneuver had a similar otolith switch rate with other maneuvers (RR = 2.13, 95% CI, 0.56–8.07, p = 0.27, Fig. 6).
Fig. 1. Flowchart for the selection procedure for studies.
outcome data (attrition bias), selective reporting (reporting bias) and other bias. There are three levels of risk assessment: low risk of bias, unclear risk of bias and high risk of bias. The flow diagram that illustrates quality assessment of the selected studies is shown in Fig. 2.
4. Discussion Gufoni maneuver is simple to perform. There are not many movements to execute, it needs low time of positioning, and positions are comfortable to the patient, making it more readily
Table 1 Characteristics of included studies. Study
Study type
Country
Participants
Diagnosis criteria
Treatment
N
Follow-up
Casani et al. [14]
RCT
Italy
HC-BPPV
Roll test
Gufoni Barbecue + FPP
58 54
24 h
Kim et al. [15]
DB-RCT
Korea
AHC-BPPV
Roll test/lying-down
Gufoni Sham Head-shaking
52 49 53
30 min to 1 h
Kim et al. [16]
DB-RCT
Korea
HC-BPPV
Roll test/lying-down
DB-RCT
Italy
HC/AHC-BPPV
Roll test
64 48 55 27/10 26/9
30 min to 1 h
Mandala et al. [17]
Gufoni Sham Barbecue Gufoni Sham
Kim et al. [18]
DB-RCT
Korea
AHC-BPPV
Roll test/lying-down
Gufoni Sham Mastoid oscillation
70 72 67
30 min to 1 h
1h
Abbreviations: RCT, randomized controlled trail; DB, double blind; FPP, forced prolonged position; HC-BPPV, horizontal canal benign paroxysmal positional vertigo with geotropic nystagmus; AHC-BPPV, horizontal canal benign paroxysmal positional vertigo with apogeotropic nystagmus.
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Fig. 2. Quality assessment of the selected studies.
acceptable [11]. And some studies reported that Gufoni maneuver is effective in treating patients suffering from HCBPPV. Vannucchi et al. reported that there is a success rate of 92% for geotropic HC-BPPV and 77% for apogeotropic HCBPPV [12]. After treatment with Gufoni maneuver in 58 geotropic HC-BPPV patients, Riggio et al. reported the success rate of 79.3% [11]. There are some reasons to explain different success rate. Firstly, HC-BPPV with apogeotropic nystagmus is more difficult to treat than that with geotropic nystagmus. Secondly, it is accepted that BPPV is spontaneously resolved. As time going, the possibility of spontaneous remission will be higher. Besides, HC-BPPV resolved significantly faster than PC-BPPV [13]. Therefore, to minimize the confounding effect of spontaneous remission and to highlight the effects of Gufoni maneuver, in this meta-analysis, we decided to evaluate immediate efficacy of short-term follow-up. Through the systematic search, the meta-analysis included 5 RCT studies to assess the immediate efficacy of Gufoni maneuver for HC-BPPV. According to different maneuvers, 5 RCT studies divided into two subgroups. A total of 427 cases (Gufoni: 223, sham: 204) were included in four studies that were about the comparison between Gufoni maneuver and sham. And we found that the Gufoni maneuver is more effective for treatment of HC-BPPV in comparison to sham. A previously systematic review revealed the similar
result [19]. However, it only included geotropic HC-BPPV. In our result, subgroup analyses showed that Gufoni maneuver had a higher immediate recovery rate than sham maneuver in treatment of apogeotropic nystagmus type of HC-BPPV. Besides, the sources of heterogeneity (I2 = 56%) were analyzed. And we found that the Mandala et al. study is the main source of heterogeneity. If we remove the Mandala et al. study, the heterogeneity will be reduced (I2 = 0%). It has some reasons to explain. Firstly, the sample size was relatively small in Mandala et al. study. Secondly, in Mandala et al. study, the effective treatment outcomes were based on most patients with geotropic nystagmus. Therefore, Gufoni maneuver has high success rate. Furthermore, the immediate efficacy between Gufoni maneuver and other maneuvers (barbecue, barbecue + FPP, mastoid oscillation and head-shaking) were compared in 473 cases in four studies (Gufoni: 244; other maneuvers: 229). And we found that immediate recovery rate did not differ between the Gufoni maneuver and other maneuvers. Subgroup analyses also showed that Gufoni maneuver treatment had similar immediate recovery rate with other maneuver treatments in HC-BPPV with geotropic and apogeotropic nystagmus. Some studies revealed the mechanism of different maneuver methods. It maybe explain the reason why there was no difference of the treatment between Gufoni maneuver and other maneuvers. The Gufoni maneuver remove otolithic
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Fig. 3. Forest plot of the immediate recovery rate of Gufoni maneuver. (1.1.1) Comparison of the immediate recovery rate between the Gufoni maneuver and sham; (1.1.2) comparison of the immediate recovery rate between the Gufoni maneuver and other maneuvers (barbecue, barbecue + FPP, mastoid oscillation and headshaking).
Fig. 4. Forest plot of the immediate recovery rate of Gufoni maneuver in HC-BPPV with geotropic nystagmus. (1.2.1) Comparison of the immediate recovery rate between the Gufoni maneuver and sham; (1.1.2) comparison of the immediate recovery rate between the Gufoni maneuver and other maneuvers.
debris by the centrifugal force created by rapid deceleration and gravitation [11]. And barbecue rotation maneuver is based on the principle of exerting an ampullofugal shift of the otolithic debris toward the canal opening to the utricle during quick head rotations in the opposite direction of the pathologic ear [20]. Both Gufoni maneuver and barbecue rotation maneuver have been reported to be effective in treating HC-BPPV (with success rates of 63% vs. 78%) [20,21]. In addition, headshaking maneuver used for treating apogeotropic HC-BPPV. It may cause accelerating decelerating power to detach the otoliths from the cupula, or to migrate the particles toward the posterior part of the horizontal semicircular canal and the debris were removed from the horizontal semicircular canal into the utricle [6,7]. Randomized controlled studies have proven that
the head-shaking maneuver has similar therapeutic efficacy as the Gufoni maneuver in treating apogeotropic HC-BPPV [15]. Mastoid oscillation is another method that causes otolith detachment for the treatment of HC-BPPV and is an effective method for treating apogeotropic HC-BPPV [8,18,22]. Another treatment, called Vannucchi’s forced prolonged position (FPP), involves having the patient lie with the unaffected ear down for approximately 12 h [6]. FPP allows the material in the nonampullar branch of the horizontal semicircular canal to gradually leave the canal and move towards the vestibule under the force of gravity [6]. The current evident result is that the success rate of the Gufoni maneuver is higher than that of Barbecue + FPP maneuver at the 24 h follow-up (86 vs. 61%) [14]. However, the two maneuvers are similar efficacious at the
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Fig. 5. Forest plot of the immediate recovery rate of Gufoni maneuver in HC-BPPV with apogeotropic nystagmus. (2.2.1) Comparison of the immediate recovery rate between the Gufoni maneuver and sham; (2.2.2) comparison of the immediate recovery rate between the Gufoni maneuver and other maneuvers.
Fig. 6. Forest plot of the comparison of otolith switch rate between the Gufoni maneuver and other maneuvers.
30th day. The author speculated that it relate to spontaneous remission phenomenon of HC-BPPV. Furthermore, the higher success rate with the Gufoni maneuver at the 24 h follow-up may explain why we observed significant heterogeneity in the Gufoni maneuver and other maneuvers on the evaluation of immediate recovery rate. Transformation of HC-BPPV into another type of BPPV can be occurred during the course of maneuver treatment [23]. The common canal transition is from the horizontal canal to the nonhorizontal canal. A total of 332 cases (Gufoni: 174, control: 158) were included in 3 studies. Overall, transition into nonhorizontal canal was observed in 10 patients and all of them showed a transition into posterior canal benign paroxysmal positional vertigo(PC-BPPV). In this meta-analysis, we found that Gufoni maneuver did not show any difference on ratio of otolith switch, as compared with the other treatment maneuvers. If otolith switch happen into PC-BPPV, all patients can be treated with the Epley or Semont maneuver. The meta-analysis conclude the evidence for a significant positive immediate efficacy of the Gufoni maneuver to treat patients with HC-BPPV. The maneuver is easy to perform and particularly suitable for older, immobile, and obese patients [11]. However, there existed several limitations. First, there are insufficient randomized clinical trials studying with Gufoni maneuver treatment of HC-BPPV. More clinical randomized clinical trials with a larger sample size are required to confirm
these results. Second, we only evaluate the immediate efficacy of the Gufoni maneuver for HC-BPPV. To avoid possible bias from the spontaneous remission which is known to be more frequent in HC-BPPV, we determined the immediate efficacy by reassessing the patients 30 min to 24 h after the physical maneuvers. Because the natural history of HC-BPPV is usually benign, with 36–88% of cases that resolve spontaneously within several days to months [13,24]. Thus, further researches need to apply the appropriate method to evaluate the long-term efficacy of the Gufoni maneuver for HC-BPPV. 5. Conclusion Gufoni maneuver has a satisfactory immediate efficacy for HC-BPPV and does not increase otolith switch rate. References [1] Nuti D, Mandala M, Salerni L. Lateral canal paroxysmal positional vertigo revisited. Ann N Y Acad Sci 2009;1164:316–23. [2] De la Meilleure G, Dehaene I, Depondt M, Damman W, Crevits L, Vanhooren G, et al. Benign paroxysmal positional vertigo of the horizontal canal. J Neurol Neurosurg Psychiatry 1996;60(1):68–71. [3] White JA, Coale KD, Catalano PJ, Oas JG. Diagnosis and management of lateral semicircular canal benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 2005;133(2):278–84. [4] Nuti D, Masini M, Mandala M. Benign paroxysmal positional vertigo and its variants. Handb Clin Neurol 2016;137:241–56.
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ANL-2613; No. of Pages 7 W. Fu et al. / Auris Nasus Larynx xxx (2019) xxx–xxx [5] Lempert T. Horizontal benign positional vertigo. Neurology 1994;44 (11):2213–4. [6] Vannucchi P, Giannoni B, Pagnini P. Treatment of horizontal semicircular canal benign paroxysmal positional vertigo. J Vestib Res 1997;7(1):1–6. [7] Oh SY, Kim JS, Jeong SH, Oh YM, Choi KD, Kim BK, et al. Treatment of apogeotropic benign positional vertigo: comparison of therapeutic head-shaking and modified Semont maneuver. J Neurol 2009;256 (8):1330–6. [8] Kim SH, Jo SW, Chung WK, Byeon HK, Lee WS. A cupulolith repositioning maneuver in the treatment of horizontal canal cupulolithiasis. Auris Nasus Larynx 2012;39(2):163–8. [9] Gufoni M, Mastrosimone L, Di NF. Repositioning maneuver in benign paroxysmal vertigo of horizontal semicircular canal. Acta Otorhinolaryngol Ital 1998;18(6):363–7. [10] Kim JS, Zee DS. Clinical practice: benign paroxysmal positional vertigo. N Engl J Med 2014;370(12):1138–47. [11] Riggio F, Dispenza F, Gallina S, Kulamarva G, Gargano R, Speciale R. Management of benign paroxysmal positional vertigo of lateral semicircular canal by Gufoni’s manoeuvre. Am J Otolaryngol 2009;30(2):106–11. [12] Vannucchi P, Asprella Libonati G, Gufoni M. The physical treatment of lateral semicircular canal canalolithiasis. Audiological Med 2005;23 (3):52–6. [13] Imai T, Ito M, Takeda N, Uno A, Matsunaga T, Sekine K, et al. Natural course of the remission of vertigo in patients with benign paroxysmal positional vertigo. Neurology 2005;64(5):920–1. [14] Casani AP, Nacci A, Dallan I, Panicucci E, Gufoni M, Sellari-Franceschini S. Horizontal semicircular canal benign paroxysmal positional vertigo: effectiveness of two different methods of treatment. Audiol Neurootol 2011;16(3):175–84. [15] Kim JS, Oh SY, Lee SH, Kang JH, Kim DU, Jeong SH, et al. Randomized clinical trial for apogeotropic horizontal canal benign paroxysmal positional vertigo. Neurology 2012;78(3):159–66.
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[16] Kim JS, Oh SY, Lee SH, Kang JH, Kim DU, Jeong SH, et al. Randomized clinical trial for geotropic horizontal canal benign paroxysmal positional vertigo. Neurology 2012;79(7):700–7. [17] Mandala M, Pepponi E, Santoro GP, Cambi J, Casani A, Faralli M, et al. Double-blind randomized trial on the efficacy of the Gufoni maneuver for treatment of lateral canal BPPV. Laryngoscope 2013;123 (7):1782–6. [18] Kim HA, Park SW, Kim J, Kang BG, Lee J, Han BI, et al. Efficacy of mastoid oscillation and the Gufoni maneuver for treating apogeotropic horizontal benign positional vertigo: a randomized controlled study. J Neurol 2017;264(5):848–55. [19] van den Broek EM, van der Zaag-Loonen HJ, Bruintjes TD. Systematic review: efficacy of Gufoni maneuver for treatment of lateral canal benign paroxysmal positional vertigo with geotropic nystagmus. Otolaryngol Head Neck Surg 2014;150(6):933–8. [20] Nuti D, Agus G, Barbieri MT, Passali D. The management of horizontal-canal paroxysmal positional vertigo. Acta Otolaryngol 1998;118 (4):455–60. [21] Fife TD, Iverson DJ, Lempert T, Furman JM, Baloh RW, Tusa RJ, et al. Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2008;70 (22):2067–74. [22] Froehling DA, Bowen JM, Mohr DN, Brey RH, Beatty CW, Wollan PC, et al. The canalith repositioning procedure for the treatment of benign paroxysmal positional vertigo: a randomized controlled trial. Mayo Clin Proc 2000;75(7):695–700. [23] Fife TD. Positional dizziness. Continuum (Minneap Minn) 2012;18 (5 Neuro-otology):1060–85. [24] Imai T, Takeda N, Ito M, Inohara H. Natural course of positional vertigo in patients with apogeotropic variant of horizontal canal benign paroxysmal positional vertigo. Auris Nasus Larynx 2011;38(1):2–5.
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