Roll maneuvers versus side-lying maneuvers for geotropic horizontal canal BPPV: a systematic review

Abstract Background The vertigo associated with horizontal canal benign paroxysmal positional vertigo (BPPV) is usually much more intense than that associated with posterior canal BPPV. In addition, horizontal canal BPPV often adversely affects dynamic balance. Objectives The purpose of this systematic review was to determine which current roll and side-lying maneuvers are most effective while treating individuals with geotropic horizontal canal BPPV. Methods CINAHL Complete, PubMed, and Web of Science were the databases accessed from inception through 2020 by all four authors. The search terms were geotropic AND (horizontal OR lateral) AND vertigo. The methodological rigor of the included studies was evaluated using a 10-item tool created by Medlicott and Harris. Results All of the maneuvers included in this systematic review demonstrated high efficacy and few contraindications. Horizontal canal BPPV tends to spontaneously resolve in a relatively short period of time secondary to the anatomical positioning of the semicircular canals. However, the maneuvers described in this systematic review may expedite the natural remission process in individuals with long-term symptoms associated with horizontal canal BPPV. Conclusions It is recommended that clinicians utilize one of the maneuvers identified in this systematic review for individuals with geotropic horizontal canal BPPV. The Gufoni maneuver might be preferable to the Baloh 360-degree roll maneuver and/or the Lempert 270-degree roll maneuver when treating individuals who are elderly, who are obese, and/or who experience immobility. If an individual is unable to tolerate a maneuver or prefers not to have one performed, forced prolonged positioning is another possible option.