Update on the treatment of benign positional paroxysmal vertigo of the horizontal semi-circular canal

BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is considered the most frequent vertigo in clinical practice, it can affect all ages, although in advanced age it can be underdiagnosed, and the fifth and sixth decade is the most affected age group. As the posterior one, lateral canalolithiasis is also susceptible to physical therapy, with maneuvers already proposed in the Guidelines for years and generally considered effective, also in the light of randomized double-blind studies. The maneuvers proposed in the 2017 guidelines, and other maneuvers proposed more recently, are taken into consideration and their effectiveness is evaluated according to what is reported in the literature. Since the results are very variable, an extensive personal review is reported regarding the Gufoni maneuver. METHODS: A total of 1008 cases of paroxysmal positional vertigo of the horizontal canal (HC), diagnosed by the Pagnini-McClure maneuver, have come to our attention in the last 20 years, both in geotropic and apogeotropic form. RESUlTS: In 347 patients with HC-VPPB the maneuver was effective in 91.2 per cent of cases in the geotropic form and in 83.5 per cent of cases in the apogeotropic form. CONClUSIONS: As with posterior canal BPPV, there are effective, well-tolerated treatments available for lateral canal BPPV, with very few side effects, which resolve the condition in most cases.