title: Efficacy of mastoid oscillation and the Gufoni maneuver for treating apogeotropic horizontal benign positional vertigo: a randomized controlled study.
abstract: To determine the immediate and short-term efficacies of mastoid oscillation vs. Gufoni maneuver in treating the apogeotropic type of horizontal canal benign paroxysmal positional vertigo (HC-BPPV), we designed a randomized, prospective, sham-controlled study. In eight dizziness clinics in Korea, 209 consecutive patients with apogeotropic HC-BPPV were enrolled. The patients were randomly assigned to receive a single application of Gufoni (n = 70), mastoid oscillation (n = 67), or sham maneuver (n = 72). Immediate and second-day responses were determined based on the results within 1 h after a single trial of each maneuver and the following day, respectively. Second-day response was assessed in patients who were non-responders on the first day. The short-term response was determined based on the cumulative response for 2 days. Successful treatment was defined as a resolution of positional nystagmus or as a transition into geotropic horizontal nystagmus (not requires vertigo symptom resolution). The immediate responses of the Gufoni maneuver (33/70, 47.1%) and mastoid oscillation (32/67, 47.8%) were better than the sham maneuver (14/72, 19.4%) (p = 0.00). The second-day results did not differ among the three groups (p = 0.76). The short-term responses showed better efficacies with the Gufoni maneuver (51/70, 76.1%) and mastoid oscillation (46/67, 71.9%) than with the sham maneuver (38/72, 53.5%) (p = 0.02). Therapeutic efficacies did not differ between the Gufoni and mastoid oscillation groups in terms of both immediate and short-term outcomes (p = 0.94, 0.57). Both the Gufoni maneuver and mastoid oscillation are valid methods for treating apogeotropic HC-BPPV, with a success rate of approximately 70% for a single maneuver during the short-term follow-up.
  
  
  BACKGROUND
  clinicaltrials.gov identifier number: NCT02046980.
authors.affiliation: Department of Neurology, Keimyung University Dongsan Hospital, 56 Dalseong-ro, Jung-gu, Daegu, 41931, South Korea.
authors.forename: Hyun Ah
authors.initials: HA
authors.lastname: Kim
authors.affiliation: Department of Neurology, Daegu Fatima Hospital, Daegu, South Korea.
authors.forename: Sang-Won
authors.initials: SW
authors.lastname: Park
authors.affiliation: Department of Neurology, Kyungil Neurologic Clinic and Internal Medicine, Daegu, South Korea.
authors.forename: Jungil
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Neurology, Andong Medical Group Hospital, Andong, South Korea.
authors.forename: Bong-Gu
authors.initials: BG
authors.lastname: Kang
authors.affiliation: Department of Neurology, Yeungnam University Medical Center, Daegu, South Korea.
authors.forename: Jun
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Neurology, Do Neurology Clinic, Daegu, South Korea.
authors.forename: Byung In
authors.initials: BI
authors.lastname: Han
authors.affiliation: Department of Neurology, School of Medicine, Catholic University of Daegu, Daegu, South Korea.
authors.forename: Jung Im
authors.initials: JI
authors.lastname: Seok
authors.affiliation: Department of Neurology, Daegu Municipal Medical Center, Daegu, South Korea.
authors.forename: Eun-Ji
authors.initials: EJ
authors.lastname: Chung
authors.affiliation: Department of Preventive Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea.
authors.forename: Jaeyoung
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Neurology, Keimyung University Dongsan Hospital, 56 Dalseong-ro, Jung-gu, Daegu, 41931, South Korea. hlee@dsmc.or.kr.
authors.forename: Hyung
authors.initials: H
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D065635:Benign Paroxysmal Positional Vertigo / Q000628:therapy; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D019416:Head Movements / Q000502:physiology; D006801:Humans; D008297:Male; D008416:Mastoid / Q000502:physiology*; D008875:Middle Aged; D009760:Nystagmus, Physiologic / Q000502:physiology*; D026741:Physical Therapy Modalities; D011187:Posture; D011446:Prospective Studies; D016896:Treatment Outcome; D014732:Vibration; D055815:Young Adult
keywords: Benign paroxysmal positional vertigo; Randomized controlled trial; Treatment outcome; Vibration