Comparison of the Efficacy of Appiani and Zuma Maneuvers in Patients with Apogeotropic Horizontal Canal Benign Paroxysmal Positional Vertigo.
Asuman Feda Bayrak, Deniz Fırat Öztürk, Baturalp Çetin
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In 30 seconds
This prospective randomized comparative study evaluated the Appiani and Zuma repositioning maneuvers in patients with unilateral apogeotropic horizontal canal benign paroxysmal positional vertigo. Among 77 patients, positional nystagmus resolved after one session in 68.4% with Appiani and 59.0% with Zuma; the difference was not statistically significant (P = .389). Overall, 63.6% achieved resolution after one session. Age ≥60 years was associated with a greater likelihood of needing at least two sessions, an exploratory finding.
Key findings
- One-session resolution occurred in 68.4% with Appiani and 59.0% with Zuma, with no significant between-group difference (P = .389).
- The overall single-session resolution rate was 63.6%.
- Patients aged ≥60 years more often required ≥2 sessions than younger patients (82.1% vs. 46.9%; P = .002).
Why it matters
Apogeotropic horizontal canal BPPV can be challenging to treat. These results suggest that both maneuvers can achieve resolution, without evidence that one is superior in this study. The association between older age and needing multiple sessions may help set expectations, although it was identified as exploratory and does not establish that age causes lower treatment response.
What to keep in mind
Patients who developed canal conversion during follow-up were excluded from efficacy analysis, which may affect interpretation of treatment outcomes.