Is the Gufoni Maneuver Safe for Elderly Patients?
Yes, the Gufoni maneuver is safe and particularly well-suited for elderly patients with lateral canal BPPV, as it is easy to perform, requires minimal patient movement, uses comfortable positions, and has short positioning times that make it ideal for older, immobile, or obese patients. 1
Why the Gufoni Maneuver is Appropriate for Elderly Patients
The American Academy of Otolaryngology-Head and Neck Surgery guidelines specifically recommend the Gufoni maneuver for treating lateral canal BPPV, with demonstrated success rates of 93% for the geotropic form. 2, 3 The maneuver's design characteristics make it especially advantageous for the elderly population:
Minimal physical demands: The procedure involves only a few simple movements—sitting to side-lying, a head turn, and return to sitting—making it feasible for patients with limited mobility. 1, 4
Short duration positioning: Patients hold positions for only 30 seconds to 2 minutes, reducing discomfort and the risk of orthostatic issues common in elderly patients. 2, 3
Comfortable positions: Unlike more complex maneuvers requiring multiple rotations, the Gufoni maneuver uses straightforward side-lying positions that elderly patients tolerate well. 4
Safety Profile and Adverse Effects
The maneuver is a mechanical treatment with no medication exposure, making it inherently safe. 3, 5 Common transient adverse effects include:
- Nausea and occasional vomiting: These are self-limiting and occur during the maneuver itself. 3, 5
- Transient sense of falling: This resolves quickly and does not contraindicate treatment. 5
- Conversion to posterior canal BPPV: This occurs in approximately 2-16% of cases depending on technique variation, but can be successfully treated with the Epley maneuver. 6, 4
No Post-Procedural Restrictions Required
Elderly patients can resume normal activities immediately after the Gufoni maneuver, as the American Academy of Otolaryngology-Head and Neck Surgery strongly recommends against post-procedural restrictions. 2, 3 This is particularly beneficial for elderly patients who may have concerns about prolonged activity limitations.
Clinical Effectiveness in Practice
Multiple studies confirm the maneuver's effectiveness across age groups, with success rates of 79-93% for symptom resolution. 2, 1, 4 A 2024 systematic review of randomized controlled trials involving patients with a mean age of 58.58 years demonstrated that the Gufoni maneuver is efficacious and should be considered a treatment option for both geotropic and apogeotropic horizontal canal BPPV. 7
Critical Considerations for Elderly Patients
Proper diagnosis must precede treatment—use the supine roll test to determine whether the patient has geotropic or apogeotropic lateral canal BPPV, as the technique differs based on which side the patient lies on initially. 3 For geotropic BPPV, the patient lies on the unaffected side; for apogeotropic BPPV, the patient lies on the affected side. 2, 3
Assess for severe cervical spine issues before performing the maneuver, though age itself is not a contraindication. 5 The maneuver's simplicity and minimal neck movement requirements make it safer than alternatives for patients with cervical concerns.