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

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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.

Trial registration: clinicaltrials.gov identifier number: NCT02046980.

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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.

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Authors and Affiliations

  1. Department of Neurology, Keimyung University Dongsan Hospital, 56 Dalseong-ro, Jung-gu, Daegu, 41931, South Korea

    Hyun Ah Kim & Hyung Lee

  2. Department of Neurology, Daegu Fatima Hospital, Daegu, South Korea

    Sang-Won Park

  3. Department of Neurology, Kyungil Neurologic Clinic and Internal Medicine, Daegu, South Korea

    Jungil Kim

  4. Department of Neurology, Andong Medical Group Hospital, Andong, South Korea

    Bong-Gu Kang

  5. Department of Neurology, Yeungnam University Medical Center, Daegu, South Korea

    Jun Lee

  6. Department of Neurology, Do Neurology Clinic, Daegu, South Korea

    Byung In Han

  7. Department of Neurology, School of Medicine, Catholic University of Daegu, Daegu, South Korea

    Jung Im Seok

  8. Department of Neurology, Daegu Municipal Medical Center, Daegu, South Korea

    Eun-Ji Chung

  9. Department of Preventive Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea

    Jaeyoung Kim

Authors
  1. Hyun Ah Kim
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  2. Sang-Won Park
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  3. Jungil Kim
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  5. Jun Lee
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  8. Eun-Ji Chung
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  9. Jaeyoung Kim
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  10. Hyung Lee
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Corresponding author

Correspondence to Hyung Lee.

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Disclosures

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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Kim, H.A., Park, SW., Kim, J. et al. Efficacy of mastoid oscillation and the Gufoni maneuver for treating apogeotropic horizontal benign positional vertigo: a randomized controlled study. J Neurol 264, 848–855 (2017). https://doi.org/10.1007/s00415-017-8422-2

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  • DOI: https://doi.org/10.1007/s00415-017-8422-2

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