​Forced prolong positioning appears to be an effective maneuver to treat canalolithiasis  however few studies exclusively examine specific technique examining efficacy and methodology for the apogeotropic variant.



Geotrophic Variant

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Forced prolonged positioning is useful for the geotropic variant of horizontal canal BPPV.  As described by Herdman, S. J, 2007 the patient should:
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1.  Lie on the ear that contains the debris
2.  Slowly roll towards the healthy ear, until it is facing downward. 

3.  Maintain this position all night 



Apogeotropic Variant 

 

 

The goal of this treatment is to assist in detachment of debris in the horizontal semicircular canal.  It involves lying down on the side of the weaker nystagmus during nightly rest for two weeks (involved side).  If nystagmus does not resolve or conversion does not occur, the patient should be instructed to lay down on the side of the stronger nystagmus (uninvolved side) (Boleas-Aguirre, Perez, & Batuecas-Caletrio, 2009).  



Boleas-Aguirre, Perez, & Batuecas-Caletrio, 2009 conducted a prospective study evaluating the effectiveness of the above protocol.  After sleeping on the involved side for two weeks, resolution of nystagmus and symptoms occurred in 15/22 subjects (68%), 1/22 subjects converted from apogeotrophic to geotrophic variant,  2/22 developed posterior canalolithiasis, and 1 developed anterior canalolithiasis. The three remaining adopted sleeping on the healthy side, with two resolving and the third began Bradt-Daroff exercises.  Overall, this treatment approach was 95.45% effective in alleviating symptoms and nystagmus (Boleas-Aguirre, Perez, & Batuecas-Caletrio, 2009). 



 

Apogeotropic variant is usually more difficult to treat,and minimal evidence exists examining efficacy and variations of forced prolonged position in this population.