Journal of Neurology

, Volume 264, Issue 5, pp 848–855 | Cite as

Efficacy of mastoid oscillation and the Gufoni maneuver for treating apogeotropic horizontal benign positional vertigo: a randomized controlled study

  • Hyun Ah Kim
  • Sang-Won Park
  • Jungil Kim
  • Bong-Gu Kang
  • Jun Lee
  • Byung In Han
  • Jung Im Seok
  • Eun-Ji Chung
  • Jaeyoung Kim
  • Hyung LeeEmail author
Original Communication


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.

Trial registration: identifier number: NCT02046980.


Randomized controlled trial Vibration Benign paroxysmal positional vertigo Treatment outcome 


Author contributions

Drs. HA Kim and H Lee designed and conceptualized the study, interpreted the data, and drafted and revised the manuscript. Dr. HA Kim wrote the manuscript and analyzed the data. Drs. SW Park, JI Kim, BG Kang, J Lee, BI Han, JI Seok, and EJ Chung contributed to the study concept and design and the revision of the manuscript. Dr. JY Kim contributed to the interpretation of the data and revision of the manuscript.

Compliance with ethical standards

Conflicts of interest



Dr. Lee serves on the editorial boards of Research in Vestibular Science, Frontiers in Neuro-otology, and Current Medical Imaging Review. The other authors report no disclosures.

Ethical standards

This study was performed in accordance with the guidelines of the 1964 Declaration of Helsinki and was approved by the local ethics committee.

Source of Funding

This work was supported by a National Research Foundation of Korea (NRF) Grant funded by the Korean Government (MSIP) (No. 2014R1A5A2010008).


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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Hyun Ah Kim
    • 1
  • Sang-Won Park
    • 2
  • Jungil Kim
    • 3
  • Bong-Gu Kang
    • 4
  • Jun Lee
    • 5
  • Byung In Han
    • 6
  • Jung Im Seok
    • 7
  • Eun-Ji Chung
    • 8
  • Jaeyoung Kim
    • 9
  • Hyung Lee
    • 1
    Email author
  1. 1.Department of NeurologyKeimyung University Dongsan HospitalDaeguSouth Korea
  2. 2.Department of NeurologyDaegu Fatima HospitalDaeguSouth Korea
  3. 3.Department of NeurologyKyungil Neurologic Clinic and Internal MedicineDaeguSouth Korea
  4. 4.Department of NeurologyAndong Medical Group HospitalAndongSouth Korea
  5. 5.Department of NeurologyYeungnam University Medical CenterDaeguSouth Korea
  6. 6.Department of NeurologyDo Neurology ClinicDaeguSouth Korea
  7. 7.Department of Neurology, School of MedicineCatholic University of DaeguDaeguSouth Korea
  8. 8.Department of NeurologyDaegu Municipal Medical CenterDaeguSouth Korea
  9. 9.Department of Preventive MedicineKeimyung University Dongsan HospitalDaeguSouth Korea

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