- Design
- Prospective randomised comparative study, single centre
- 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, where nystagmus beats away from the ground on supine roll testing, responds less reliably to treatment than the more common forms. A Turkish trial randomised 77 patients with unilateral disease confirmed on videonystagmography to the Appiani manoeuvre or the Zuma manoeuvre, allowing up to four sessions.
One session resolved positional nystagmus in 68.4% with Appiani and 59.0% with Zuma, a difference that was not significant. Overall, about two-thirds resolved after one session. Patients aged 60 or over needed two or more sessions in 82% of cases, against 47% of younger patients.
The trial is small and single-centre, and patients whose BPPV converted to another canal were excluded from the efficacy analysis. But it supports using whichever of the two manoeuvres a clinician performs confidently, and warning older patients to expect more than one visit.
Correct diagnosis matters as much as the manoeuvre: the apogeotropic form must be recognised on roll testing and the affected side identified before treatment.
- Perform a supine roll test in positional vertigo not explained by Dix-Hallpike testing.
- Use either the Appiani or Zuma manoeuvre for apogeotropic horizontal canal BPPV.
- Tell patients aged 60 or over that more than one session is likely.
- Recheck after each session and watch for conversion to another canal.
Why it matters
It removes a choice between two manoeuvres and sets realistic expectations for older adults.
Don't overread it
With 77 patients, a modest advantage for either manoeuvre cannot be excluded.
The statistics, in plain English
A 9-point difference in resolution (68% vs 59%) with P=0.39 means the trial could not tell the manoeuvres apart; a larger trial might.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for ent & head and neck surgery, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free