II. Indications

  1. Benign Paroxysmal Positional Vertigo (BPPV) affecting the anterior semicircular canal (superior canal)
    1. Procedure is diagnostic and therapeutic

III. Technique

  1. Patient moves from seated position to lying supine
    1. Patient's head should overhang the end of the table
    2. Patient should extend their neck as much as possible (at least 30 degrees), so they are looking at the wall behind them
  2. Observe for Downbeat Nystagmus (Vertical Nystagmus) as patient moves into this position
    1. Vertical Nystagmus is otherwise a sign of cerebellar lesion (perform a careful Neurologic Exam)
    2. Nystagmus may also be torsional toward the affected ear
  3. Maneuver
    1. Patient remains supine with neck extended for 3 minutes
    2. Next, patient flexes their neck (chin to chest) as much as possible for 3 minutes
  4. Completion
    1. Assist the patient back to a seated position

IV. Resources

  1. Anterior Canal BPPV (YouTube, Peter Johns, MD)
    1. https://www.youtube.com/watch?v=2TAYDp3vVTU

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