Please be aware of the following before you proceed.
You can use this maneuver to convert apogeotropic nystagmus to geotropic nystagmus.
If you do the conversion right, you can perform the Lempert 360-degree roll away from the affected side to further remediate lateral canal BPPV.
This maneuver requires brisk head movements and may not be well-tolerated by elderly patients.
Before performing the Vannucchi-Asprella maneuver, it is important to find out whether the patient has current or past injuries of the neck or spine.
It is most helpful to use Video Frenzel or VNG goggles while performing the Vannucchi-Asprella maneuver.
This reduces the ability of the patient to fixate during the procedure to reduce the nystagmus response.
This will also allow the examiner to see even very slight horizontal nystagmus.
If any neurological symptoms occur during the execution of the maneuver, stop the procedure immediately and refer for a neurological evaluation.
These symptoms might include blurred vision, numbness, weakness of the arms or legs or confusion.
Let’s dive into the maneuver, step-by-step.
Have the patient sit length-wise on the examination table (Figure 1).
Figure 1: Begin with patient seated length-wise on the table.
With a rapid motion, guide the patient into a supine position (Figure 2) and immediately rotate the patient’s head away from the affected ear (Figure 3).
Figure 2: Guide the patient to a supine position.
Figure 3: Immediately rotate the head away from the affected ear.
While maintaining the turned head position, guide the patient back into a length-wise sitting position as in step 1.
Repeat steps 1-3 six to eight times in rapid succession.
Paolo Vannucchi, Guiseppe Asprella Libonati & Mauro Gufoni (2005) The Physical Treatment of Lateral Semicircular Canal Canalolithiasis, Audiological Medicine, 3:1, 52-56, DOI: 10.1080/16513860510029445.
White JA, Coale KD, Catalano PJ, Oas JG. Diagnosis and management of lateral semicircular canal benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2005 Aug;133(2):278-84. doi: 10.1016/j.otohns.2005.03.080. PMID: 16087028.
Ciniglio Appiani G, Gagliardi M, Magliulo G. Physical treatment of horizontal canal benign positional vertigo. Eur Arch Otorhinolaryngol. 1997;254(7):326-8. doi: 10.1007/BF02630724. PMID: 9298668.