Abstract

Introduction: The “barbecue rotation” is an effective physical treatment for horizontal canal benign paroxysmal positional vertigo. The barbecue rotation is slightly less successful than forced prolonged position, but this maneuver has more immediate results. So we first try barbecue rotation and then propose prolonged position toward healthy side for up to 12 hours. When we try barbecue rotation, we often can see geotropic or apogeotropic nystagmus during last step of barbecue rotation. The objective of this study is to evaluate effectiveness of this maneuver by nystagmus appeared during last step of barbecue rotation.
Case
presentation: A 70-year-old woman presented with positional vertigo. Rapid head rotation of the head to the left or to the right with the patient in the supine position induced vertigo and purely horizontal nystagmus toward the lower ear(geotropic) lasting for 40-50 seconds, more pronounced with movement to the right. In order to clear right horizontal canal from mobile particles, we applied a 360°rotation around the longitudinal axis in four quick steps of 90°toward the left, starting from the right. During the last step, we observed nystagmus toward uppermost ear(apogeotropic) lasting for 30 seconds. Immediate after this procedure, rotation of the head to either side in the supine position provoked no any nystagmus. And then Dix-Hallpike positioning to the right revealed right beating horizonto-torsional nystagmus. After a single modified Epley maneuver, all positional vertigo and nystagmus ceased.
Conclusion
we divided three groups 1) no nystamus : successful treatment, 2) geotropic nystagmus : fail in 4 step, 3) apogeotropic nystamus : fail in 3 step or repositioning to the posterior canal, but no cupulolithiasis.