Gufoni Maneuver for Right Horizontal Canal-Cupulolithiasis (Apgeotropic Nystagmus)

The Gufoni Maneuver can be used to treat horizontal canal cupulolithaisis. 1. The patient starts in a seated position. 2. The patient transitions quickly to lying on their affected side. 3. The patient lies on their affected side for two minutes with the head in a neutral position. 4. The patient's head is rotated 45 degrees upwards (nose pointing towards the ceiling), and this position is maintained for two minutes. There is currently no way to identify if the otoconia are adherent to the utricle or canal side of the cupula-as deflection of the cupula would produce similar nystagmus. Therefore, we recommend modifying this repositioning maneuver accordingly if the individual does not respond to treatment (nose up versus nose down). Antecedently, some clinicians remember this maneuver with the mnemonic "Apo, Affected, Away," meaning apogeotropic nystagmus will lead the patient to transition onto their affected side, and then the patient's head will be rotated to the away from the ground.