What is the Yacovino maneuver and is it a recommended medical procedure?

Yacovino Maneuver for Anterior Canal BPPV

What It Is

The Yacovino maneuver is a specific canalith repositioning procedure designed to treat anterior semicircular canal benign paroxysmal positional vertigo (AC-BPPV), a rare variant comprising approximately 3% of all BPPV cases. 1

Clinical Effectiveness

• The Yacovino maneuver demonstrates overall success rates of 75-85.6% for treating AC-BPPV, comparable to treatment outcomes for more common posterior and lateral canal variants 1
• The maneuver is significantly more effective for canalolithiasis (free-floating debris) than cupulolithiasis (debris adhered to the cupula), with 13 of 17 canalolithiasis patients cured after initial treatment versus only 4 of 11 cupulolithiasis patients 2
• After one week of repeated treatments, cumulative success reaches 21 of 34 canalolithiasis cases and 7 of 18 cupulolithiasis cases 2

When to Use It

Perform the Yacovino maneuver when AC-BPPV is diagnosed based on:

• Down-beating nystagmus (with or without torsional component) on Dix-Hallpike or straight head-hanging tests 2
• Typical BPPV history with positional vertigo lasting less than 60 seconds 1
• Presence of BPPV in other canals that subsequently converts to anterior canal involvement 2
• Failure of posterior canal treatment maneuvers when down-beating nystagmus persists 1

Diagnostic Considerations

• The straight head-hanging (SHH) test is more sensitive than the Dix-Hallpike test for AC-BPPV, showing down-beating nystagmus in 33 of 40 patients versus 26 of 40 patients respectively 2
• Down-beating nystagmus alone appeared in 79% of cases, while down-beating with torsional nystagmus occurred in 21% 2
• Diagnosis can be confirmed retrospectively by treatment effectiveness with the Yacovino maneuver itself, particularly when combined with follow-up outcomes or observation of canal conversion 2

Treatment Protocol

Execute the Yacovino maneuver with the following steps:

1. Start with patient sitting upright
2. Rapidly move patient to supine position with head hyperextended (hanging off table edge)
3. Quickly flex the head and neck, bringing chin to chest
4. Return patient to sitting position with head maintained in flexed position
5. Hold each position for 20-30 seconds or until nystagmus resolves 1, 3

Repeat Treatment Strategy

• If initial maneuver fails, repeat the procedure during the same visit 1
• Schedule follow-up within one week for persistent cases 2
• Consider alternative diagnosis if symptoms persist after multiple properly executed maneuvers 4

Important Clinical Pitfalls

• AC-BPPV has a lower spontaneous resolution rate and lower treatment success rate compared to posterior canal BPPV, requiring realistic patient counseling 4
• Some patients (approximately 3 of 9 in one series) may show persistent positional nystagmus for 7-12 months despite repeated treatments 4
• The maneuver's effectiveness depends critically on proper execution with adequate head hyperextension and rapid transitions between positions 3
• No postprocedural restrictions are needed after the Yacovino maneuver, consistent with recommendations for other BPPV treatments 5

Multi-Canal BPPV Considerations

• AC-BPPV frequently coexists with posterior canal (11 of 40 patients) or horizontal canal BPPV (10 of 40 patients) 2
• When treating combined canal involvement, address the most symptomatic canal first, then reassess with positional testing 6
• The Yacovino maneuver can be combined with Epley or barbecue roll maneuvers when multiple canals are affected 6

Safety Profile

• The Yacovino maneuver is a mechanical treatment with no medication exposure, making it safe for use in pregnancy 7
• Common transient adverse effects include nausea and brief worsening of vertigo during the procedure, which are self-limiting 1
• Exercise caution in patients with cervical spine limitations, severe kyphoscoliosis, or conditions limiting neck range of motion, similar to contraindications for the Dix-Hallpike maneuver 5