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Gufoni Maneuver for Geotropic Lateral Canal BPPV

Updated March 2021 by Michelle Petrak, Ph.D.


Tips before performing the Gufoni maneuver

Please consider the following precautions before the test.


1. Past injuries

Before performing the Gufoni maneuver, it is important to find out whether the patient has current or past injuries of the neck or spine.


2. Neurological symptoms

If any neurological symptoms occur during the execution of the Gufoni maneuver, stop the procedure immediately and refer for neurological evaluation.

These symptoms might include, blurred vision, numbness, weakness of the arms or legs or confusion.


3. The Gufoni maneuver is an alternative treatment

This procedure is an alternative treatment for patients who cannot complete the Lempert 360-degree Roll, as well as for cases where an apogeotropic lateral canal variant may be present.


4. Appiani maneuver

The Gufoni maneuver is also known as the Appiani maneuver.


How to perform the Gufoni maneuver

The Gufoni maneuver is rather simple, outlined in the following steps.


Step 1

Begin with the patient sitting on the edge of the examination table, facing the examiner (Figure 1).

Female patient sitting on the edge of an examination table. She is wearing VNG goggles.

Figure 1: Patient sitting on examination table.


Step 2

With a rapid motion, guide the patient into a side-lying position toward the unaffected side (Figure 2).

Female patient in side-lying position on examination table, with legs hanging off the side. She is wearing VNG goggles.

Figure 2: Patient in side-lying position.


Step 3

While the patient is lying on his/her side, turn the patient’s head to a 45‑degree angle with a quick movement (so that the patient’s nose is pointing toward the table) (Figure 3).

Hold this position for 2-3 minutes.

Female patient in side-lying position on examination table, with legs hanging off the side and head turned to a 45-degree angle. She is wearing VNG goggles.

Figure 3: Patient in side-lying position with head turned to a 45-degree angle.


Step 4

Guide the patient back into a sitting position.



Gufoni M, Mastrosimone L, Di Nasso F. Trattamento con manovra di riposizionamento per la canalolitiasi orizzontale [Repositioning maneuver in benign paroxysmal vertigo of horizontal semicircular canal]. Acta Otorhinolaryngol Ital. 1998 Dec;18(6):363-7. Italian. PMID: 10388148.

Ciniglio Appiani G, Catania G, Gagliardi M. A liberatory maneuver for the treatment of horizontal canal paroxysmal positional vertigo. Otol Neurotol. 2001 Jan;22(1):66-9. doi: 10.1097/00129492-200101000-00013. PMID: 11314719.

Hughes CA, Proctor L. Benign paroxysmal positional vertigo. Laryngoscope. 1997 May;107(5):607-13. doi: 10.1097/00005537-199705000-00010. PMID: 9149161.


About the author

Michelle Petrak, Ph.D.

Michelle Petrak, Ph.D., is the Director of Clinical Audiology and Vestibular Research for Interacoustics. Her primary role is development and clinical validation of new technologies in the vestibular and balance areas. She is located in Chicago where she is a licensed private practice clinical audiologist at Northwest Speech and Hearing (NWSPH). Dr. Petrak received her doctorates in Electrophysiology (1992) and Biomolecular Electronics (1994) from Wayne State University and her Masters in Audiology in 1989. Her special areas of expertise include vestibular and balance assessments and management of the dizzy patient. Dr. Petrak is involved with new innovative product developments, clinical evaluations of new protocols, and publishing, teaching, and training on the management of patients with dizziness. She continues to lecture extensively nationally and internationally, and she has numerous articles published in the hearing industry journals. She also participates on the committees for several doctoral students as support for the research projects.

March 2017
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