What is the procedure for performing the Gufoni maneuver for benign paroxysmal positional vertigo (BPPV)?

How to Perform the Gufoni Maneuver

The Gufoni maneuver is performed differently depending on whether you are treating geotropic or apogeotropic lateral semicircular canal BPPV, with the key distinction being which side the patient lies on initially. 1

For Geotropic Lateral Canal BPPV (Most Common Form)

For geotropic lateral canal BPPV, the Gufoni maneuver achieves 93% success rates and is more effective than the barbecue roll maneuver (81% success). 1, 2

Step-by-Step Procedure:

1. Start with the patient sitting upright 1

2. Rapidly move the patient from sitting to a straight side-lying position on the UNAFFECTED side (the side WITHOUT the BPPV) and hold for approximately 30 seconds 1

3. Quickly turn the patient's head toward the ground 45°-60° (nose-down position) and hold this position for 1-2 minutes 1

4. Return the patient to sitting with the head held toward the left shoulder (for right-sided BPPV) until fully upright, then straighten the head 1

Critical Point for Geotropic Form:

The patient lies on the unaffected ear (the side that does NOT have BPPV). 1, 3

For Apogeotropic Lateral Canal BPPV (Less Common Form)

For apogeotropic lateral canal BPPV, the Gufoni-Appiani variant achieves 71.4% success rates, superior to barbecue roll (33.3%) and Zuma-e-Maia maneuvers. 2

Step-by-Step Procedure:

1. Start with the patient sitting upright 1

2. Rapidly move the patient from sitting to a straight side-lying position on the AFFECTED side (the side WITH the BPPV) and hold for approximately 30 seconds 1

3. Quickly turn the patient's head toward the ground 45°-60° and hold this position for 1-2 minutes 1

4. Return the patient to sitting with the head held toward the opposite shoulder until fully upright, then straighten 1

Critical Point for Apogeotropic Form:

The patient lies on the affected ear (the side that HAS BPPV). 1

Important Clinical Considerations

Diagnosis Must Precede Treatment:

• You must first diagnose lateral canal BPPV using the supine roll test and determine whether it is geotropic or apogeotropic before performing the Gufoni maneuver. 1, 3
• Determining the correct affected side is paramount, as treating the wrong side will be ineffective. 1

Efficacy and Expectations:

• Single maneuver resolution occurs in approximately 48-68% of geotropic cases 4, 2
• Success rates increase to 75% after up to 4 maneuvers during the first visit and 93.8% after one week of follow-up 2
• The Gufoni maneuver is significantly more effective than the barbecue roll for geotropic lateral canal BPPV (68% vs 34.8%, p=0.021) 2

Common Pitfalls:

• Apogeotropic BPPV shows very low immediate resolution rates with the Gufoni maneuver (0% in one study), with spontaneous resolution during follow-up often exceeding immediate treatment success 5
• Faster execution of the maneuver (within 1 second) provides no additional benefit over slower movements 6
• Canal conversion to posterior canal BPPV occurs in 6.9-16% of cases during treatment and requires switching to Epley or Semont maneuvers 4, 7

Post-Procedure Management:

• No postprocedural restrictions are needed—patients can resume normal activities immediately 3
• The maneuver can be repeated if symptoms persist, with cumulative success rates improving with repeated attempts 2

Safety Profile:

• The maneuver is safe in pregnancy as it is a mechanical treatment with no medication exposure 3
• Common transient adverse effects include nausea, occasional vomiting, and sense of falling, which are self-limiting 3