Horizontal canal cupulolithiasis
Horizontal canal cupulolithiasis is characterized by positional vertigo and nystagmus beating to the uppermost (apogeotropic) ear induced by turning the head to the right or left during the diagnostic head roll test.
In horizontal canal cupulolithiasis, otolith debris is presumed to be attached to either the utricular or canal side of the cupula of the ampulla. However, clinicians cannot differentiate between the two types during the head roll test, as they may both show the same kind of apogeotropic horizontal nystagmus. Therefore, a treatment that can be applied regardless of the side of the cupula where the otoliths are attached is ideal.
How is the Kim Maneuver for horizontal canal cupulolithiasis performed?
✅ The patient starts in a supine position.
✅ The patient turns 135 degrees to the affected side.
✅ Apply the vibration tool to the affected side for 30 seconds to detach the otoconia from the cupula.
✅ The patient turns 45 degrees towards the unaffected side (side-lying on the affected side).
✅ The patient turns 90 degrees towards the unaffected side (supine position).
✅ The patient turns 90 degrees towards the unaffected side (side-lying on the unaffected side).
✅ Apply the vibration tool to the affected side for 30 seconds.
✅ The patient continues to turn 90 degrees in the same direction into the prone position.
✅ Each position should be held for 3 minutes to allow all the detached otoconia to be completely repositioned.
From the prone position, the patient can be assisted into a sitting position, continue to roll onto the affected side from the prone position, or get up from a hands-and-knees position while keeping the neck and head neutral.
Have you tried the Kim Maneuver for horizontal canal cupulolithiasis? 👉🏼
(Post created in collaboration with Sonia Vovan - All In Your Head)
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