A new treatment (the affected-ear-up 90° maneuver) for benign paroxysmal positional vertigo of the lateral semicircular canal

Background: Although several researchers have tried various kinds of canalith repositioning procedures for lateral canalolithiasis, a standard treatment has not been established. We have adopted 90 degrees rotation, which is anatomically appropriate.Objective: To clarify the efficacy of the affected-ear-up 90 degrees maneuver.Materials and methods: The subjects were 23 consecutive patients (15 females, 8 males) who revealed transient direction-changing geotropic positional nystagmus. After determining the affected side, we immediately performed the canalith repositioning procedure. To perform this maneuver: (1) Place the patient in the supine position. (2) Rotate the head toward the healthy side until 90 degrees from the supine. (3) Sit up. (4) Ask the patient to remain upright with the chin down until going to bed.Results: Nineteen patients (83%) became symptom-free by only one maneuver. However, three patients converted to ipsilateral cupulolithiasis of the lateral canal, and one patient required a second maneuver.Conclusion: The affected-ear-up 90 degrees maneuver is effective against lateral canalolithiasis.