Simple methods for determining the affected side and performing otolith repositioning in cases of lateral semicircular canal-benign paroxysmal positional vertigo-canalolithiasis: Healthy-ear-down 135° maneuver and affected-ear-down 135° maneuver

To develop simple and effective methods for determining the affected side and promoting early symptom resolution in lateral semicircular canal-benign paroxysmal positional vertigo (L-BPPV) due to canalolithiasis, including its geotropic (L-BPPV-can-geo) and apogeotropic (L-BPPV-can-apo) variants.

Clinicians managing lateral canal BPPV canalolithiasis should review this study's proposed maneuvers as potential simple alternatives for side identification and repositioning, but await independent replication before replacing established protocols such as the Gufoni or BBQ roll maneuver.

Lateral semicircular canal BPPV is commonly misdiagnosed or under-treated due to difficulty identifying the affected side; simpler, reliable maneuvers could meaningfully improve first-visit resolution rates in vestibular clinics.

1. 01Two new maneuvers proposed: healthy-ear-down 135° and affected-ear-down 135°.
2. 02Targets lateral semicircular canal BPPV canalolithiasis, a frequent but tricky BPPV subtype.
3. 03First maneuver aids affected-side identification; second performs otolith repositioning.
4. 04Published in Auris Nasus Larynx (2026); PMID 42119172.
5. 05Method is described as 'simple,' potentially lowering the procedural skill threshold.

PMID

42119172

DOI

10.1016/j.anl.2026.04.013.

Journal

Auris Nasus Larynx

Publication type

research_article

Evidence level

4

Population

Patients with lateral semicircular canal BPPV canalolithiasis

Intervention

Healthy-ear-down 135° maneuver and affected-ear-down 135° maneuver