​Geotrophic Variant ​

1.  Start sitting edge of table.
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2.  Patient is brought to side-lying on the uninvolved side, and head is maintained horizontal (do not tilt head towards table).  

3.  Patient briskly turns head 45 degrees down towards the table.





Apogeotrophic Variant


1.  Start with the patient sitting at the edge of the table. 

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2.  Patient is brought to side-lying on the involved side, and head is maintained  facing horizontally (do not tilt head towards table).



3.  Patient briskly turns head 45 degrees down towards the table.  This position should be maintained for 2 to 3 minutes (Mandala et al., 2013).  



Evidence:​



In a double blind randomized control study conducted by Mandala et al., 2013, 72 patients with both apogeotrophic and geotrophic variant were assigned to one of two groups.  Group A received sham treatment, and group B patients received two consecutive Gufoni maneuvers, followed by no post maneuver instructions (Sham treatment was the Gufoni maneuver performed to the opposite side).  At the one hour follow up, 75.7% of patients recovered in the experimental group, compared to 8.6% of patients in the sham group.  After 24 hours, 83.8% of patients were BPPV free, versus 11.4% in the sham group.  The technique was significantly more effective for geotropic variant compared to the apogeotrophic variant (Mandala et al., 2013).  



This technique may be useful if patient is unable to tolerate the log roll maneuver.