- Design
- Prospective randomised comparative study
- Population
- 77 adults with unilateral apogeotropic horizontal canal BPPV
- Primary outcome
- Resolution of positional nystagmus
- Effect
- One-session resolution 68.4% Appiani vs 59.0% Zuma (P=0.389)
Apogeotropic horizontal canal BPPV, in which nystagmus beats away from the ground on the supine roll test, responds less well to repositioning than the geotropic form. This Turkish study randomised 77 patients with the unilateral apogeotropic form, confirmed on videonystagmography, to the Appiani or the Zuma manoeuvre, with up to four sessions.
One session resolved positional nystagmus in 68.4% with Appiani and 59.0% with Zuma, a difference compatible with chance. Overall, 64% resolved after one session. Patients aged 60 or over were much more likely to need two or more sessions (82% vs 47%).
The study is small and patients whose BPPV converted to another canal were excluded from the efficacy analysis. Still, it suggests either manoeuvre is a reasonable first choice.
In clinic, the key steps are correctly identifying the variant and side, and warning older patients that more than one visit is likely.
- Perform the supine roll test to identify horizontal canal BPPV and its direction
- Either the Appiani or Zuma manoeuvre is reasonable for the apogeotropic form
- Warn patients aged 60 or over that two or more sessions are often needed
- Re-test after each manoeuvre and watch for conversion to another canal
Why it matters
It gives head-to-head data for a BPPV variant that often frustrates first attempts.
The statistics, in plain English
68% versus 59% with P=0.39 means the gap is compatible with chance. With 77 patients, the study could only detect large differences.
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