Search

Purpose: This review aims to investigate the effects of the Gufoni maneuver on horizontal semicircular canal benign paroxysmal positional vertigo (HC-BPPV). Methods: A comprehensive search, including PubMed, PEDro, REHABDATA, SCOPUS, EMBASE, and Web of Science, was conducted to determine randomized clinical trials (RCTs) studying the effects of the Gufoni maneuver for HC-BPPV from inception to March 1, 2024. The quality of the included studies was estimated using the Physiotherapy Evidence Database (PEDro) scale. Results: Ten randomized controlled trials (RCTs) were included in this review with a total of 1025 HC-BPPV patients (mean age = 58.58 years; 63% female; 55% right-side HC-HBPPV; 49% geotropic HC-BPPV). The included RCTs ranged from 4 to 9 out of 10 (median = 6.5) on the PEDro scale. The included studies showed that the Gufoni maneuver revealed efficacy when compared to the sham maneuver but not when compared to other maneuvers such as the Barbecue roll maneuver, the Appiani maneuver, the Mastoid oscillation, the head shaking, and the modified Gufoni maneuver. Conclusions: The Gufoni maneuver is considered an option for treating patients with geotropic or apogeotropic HC-BPPV. Precise diagnosis of the BPPV, the subtype of HC-BPPV, symptom duration, history of previous BPPV attacks, the applied methods of maneuver and the proficiency of the clinician performing the maneuver, proper diagnosis, presence of any underlying health conditions are critical for successful treatment. Further studies are strongly warranted. [ABSTRACT FROM AUTHOR]

Geotropic horizontal canal BPPV may be effectively treated using roll maneuvers or side-lying maneuvers. Forced prolonged position (FPP), initially described in 1997, may be used alone or in conjunction with these roll maneuvers or side-lying maneuvers in the treatment of geotropic horizontal canal BPPV. The purpose of this systematic review was to determine the effectiveness of FPP for the treatment of geotropic horizontal canal BPPV. A literature search was conducted using CINAHL Complete, ProQuest Medical Database, PubMed, Web of Science, and Wiley Online Library as the databases. The search terms applied were geotropic AND (horizontal OR lateral) AND vertigo AND ('forced prolonged position' OR 'forced prolonged positioning'). The efficacy of FPP ranged between 73.0% and 100.0% for the resolution of the vertigo and/or nystagmus associated with geotropic horizontal canal BPPV. FPP appears to be a more suitable intervention than roll maneuvers for individuals with physical impairments such as age-related limitations, obesity, neck pain, back pain, and/or other musculoskeletal disorders. Although the Gufoni maneuver, the most common side-lying maneuver, requires much less time to perform than FPP and may be more appropriate for those individuals who are unable to maintain a side-lying position for a prolonged period, the quick movements required for the performance of this intervention can elicit severe neurovegetative symptoms. Therapists should consider using FPP with individuals who have been diagnosed with geotropic horizontal canal BPPV. FPP might be effective if used independently or in combination with another intervention, such as the Gufoni maneuver. [ABSTRACT FROM AUTHOR]

A 2021 systematic review reported that all of the included maneuvers for the treatment of geotropic horizontal canal benign paroxysmal positional vertigo (BPPV) demonstrated high efficacy and few contraindications. However, a similar systematic review for the apogeotropic subtype of horizontal canal BPPV has not been published. The purpose of this systematic review was to evaluate the effectiveness of current treatment options for apogeotropic horizontal canal BPPV. The databases accessed from inception through 2021 were CINAHL Complete, PubMed, and Web of Science. The search terms utilized were (ageotropic OR apogeotropic) AND (horizontal OR lateral) AND vertigo. A 10-item tool developed by Medlicott and Harris was utilized to assess methodological rigor. Three of the included maneuvers (the Gufoni maneuver, the Zuma maneuver, and the Cupulolith Repositioning maneuver) demonstrated 100% efficacy after only one treatment session. The Gufoni maneuver may be preferable for individuals who are elderly, obese, or have problems with their general mobility because it does not require the individual to perform a roll. Although the Zuma maneuver is also easy to perform on these types of individuals, only one study has been completed on this maneuver. Because the Cupulolith Repositioning maneuver is a roll maneuver, it may not be tolerated by all individuals. The Gufoni maneuver may be the best maneuver to initially consider because it has been more well-studied than the Zuma maneuver; and it may be more comfortable than the Cupulolith Repositioning maneuver for certain types of individuals. [ABSTRACT FROM AUTHOR]

Objective: We aimed to describe the clinical features of the apogeotropic variant of horizontal canal benign paroxysmal positional vertigo (HC BPPV-AG) in a cluster of patients with restrictive neck movement disorders and a new therapeutic manoeuvre for its management. Methods: In a retrospective review of cases from an ambulatory tertiary referral center, patients with HC BPPV-AG in combination with neck movement restriction that prevented any classical manual repositioning procedure or who were refractory to canalith repositioning manoeuvres, were treated with a new manoeuvre comprised of sequential square-wave pattern of head and body supine rotations while nystagmus was being monitored, until either an apogeotropic to geotropic conversion or resolution of the nystagmus was observed. Results: Fifteen patients were studied. All but one [14/15 cases] showed a positive therapeutic response to the repositioning procedure in a single session. In two cases, a direct relief of vertigo and elimination of nystagmus was observed without an intermediate geotropic phase. Although in three patients the affected ear was not initially identified, it was ultimately identified and successfully treated by the square wave manoeuvre in all of them. Conclusions: The square-wave manoeuvre is an alternative for HC BPPV-AG treatment in either cases with neck restriction, where the affected side is not well identified at the bedside or when other manoeuvres fail to resolve the HC BPPV-AG.

Background and Objectives: The aim of this study was to show with three-dimensional simulations how the diagnostic supine roll test (SRT) is affected by the initial position of the debris within the horizontal canal (hc) and study the nystagmus patterns on changing the sequence of testing and its impact on the diagnosis of the side of involvement in hc-BPPV. Methods: A 3D dynamic simulation model was developed and applied based on reconstructed MRI images and fluid dynamics. Each semicircular canal was linked to the respective extraocular muscles to visualize nystagmus generated on stimulation of the canal. Results: The simulations of hc-canalithiasis showed that the nystagmus pattern seen with the SRT is changed by the initial position of the otolith debris within the canal and the sequence of testing. The debris changes position during SRT so that sequential steps do not start at the initial position as previously assumed. The sequence of performing the SRT steps from the right or left side influences the nystagmus pattern generated: bilateral direction-changing, bilateral direction-fixed, and unilateral nystagmus can be seen in different test conditions. The SRT itself may even reposition the debris out of the canal. Conclusions and Clinical Implications: Simulations provide a dynamic tool to study the diagnostic SRT in hc-canalithiasis. Starting the SRT from right or left has a major impact on the test outcome (unlike the Dix-Hallpike maneuver). The findings provide a new interpretation for the results of the SRT. The simulations explain the phenomenon of direction-fixed nystagmus as a logical consequence of starting the SRT with the head turned toward the non-affected side in hc-canalithiasis with debris in the ampullary arm. They also show that unilateral nystagmus seen on SRT indicates canalithiasis of the non-ampullary arm of the side opposite to the side of nystagmus. The generation of bilateral direction-changing, bilateral direction-fixed, and unilateral nystagmus can be the cause of misdiagnoses in terms of the affected side and underlying mechanisms. Finally, a recommendation for a standardized protocol for the sequence of positional tests should be established to ensure uniform interpretation of test results. [ABSTRACT FROM AUTHOR]

Background and ObjectivesThe aim of this study was to show with three-dimensional simulations how the diagnostic supine roll test (SRT) is affected by the initial position of the debris within the horizontal canal (hc) and study the nystagmus patterns on changing the sequence of testing and its impact on the diagnosis of the side of involvement in hc-BPPV.MethodsA 3D dynamic simulation model was developed and applied based on reconstructed MRI images and fluid dynamics. Each semicircular canal was linked to the respective extraocular muscles to visualize nystagmus generated on stimulation of the canal.ResultsThe simulations of hc-canalithiasis showed that the nystagmus pattern seen with the SRT is changed by the initial position of the otolith debris within the canal and the sequence of testing. The debris changes position during SRT so that sequential steps do not start at the initial position as previously assumed. The sequence of performing the SRT steps from the right or left side influences the nystagmus pattern generated: bilateral direction-changing, bilateral direction-fixed, and unilateral nystagmus can be seen in different test conditions. The SRT itself may even reposition the debris out of the canal.Conclusions and Clinical ImplicationsSimulations provide a dynamic tool to study the diagnostic SRT in hc-canalithiasis. Starting the SRT from right or left has a major impact on the test outcome (unlike the Dix-Hallpike maneuver). The findings provide a new interpretation for the results of the SRT. The simulations explain the phenomenon of direction-fixed nystagmus as a logical consequence of starting the SRT with the head turned toward the non-affected side in hc-canalithiasis with debris in the ampullary arm. They also show that unilateral nystagmus seen on SRT indicates canalithiasis of the non-ampullary arm of the side opposite to the side of nystagmus. The generation of bilateral direction-changing, bilateral direction-fixed, and unilateral nystagmus can be the cause of misdiagnoses in terms of the affected side and underlying mechanisms. Finally, a recommendation for a standardized protocol for the sequence of positional tests should be established to ensure uniform interpretation of test results.

The vertigo associated with horizontal canal benign paroxysmal positional vertigo (BPPV) is usually much more intense than that associated with posterior canal BPPV. In addition, horizontal canal BPPV often adversely affects dynamic balance. The purpose of this systematic review was to determine which current roll and side-lying maneuvers are most effective while treating individuals with geotropic horizontal canal BPPV. CINAHL Complete, PubMed, and Web of Science were the databases accessed from inception through 2020 by all four authors. The search terms were geotropic AND (horizontal OR lateral) AND vertigo. The methodological rigor of the included studies was evaluated using a 10-item tool created by Medlicott and Harris. All of the maneuvers included in this systematic review demonstrated high efficacy and few contraindications. Horizontal canal BPPV tends to spontaneously resolve in a relatively short period of time secondary to the anatomical positioning of the semicircular canals. However, the maneuvers described in this systematic review may expedite the natural remission process in individuals with long-term symptoms associated with horizontal canal BPPV. It is recommended that clinicians utilize one of the maneuvers identified in this systematic review for individuals with geotropic horizontal canal BPPV. The Gufoni maneuver might be preferable to the Baloh 360-degree roll maneuver and/or the Lempert 270-degree roll maneuver when treating individuals who are elderly, who are obese, and/or who experience immobility. If an individual is unable to tolerate a maneuver or prefers not to have one performed, forced prolonged positioning is another possible option. [ABSTRACT FROM AUTHOR]

Background and purpose: Horizontal canal benign paroxysmal positional vertigo (BPPV) is the second most common variant of BPPV after posterior canal BPPV. Various liberatory maneuvers are recommended for the treatment of horizontal canal BPPV canalithiasis (hc‐BPPV‐ca). The aim of this study was to show how three‐dimensional (3D) dynamic simulation models visualize the movement of the clot of otoconia within the canal for a better understanding of the theoretical efficacy. Methods: Based on reconstructed magnetic resonance imaging and fluid dynamics, a 3D dynamic simulation model (as a function of time) was developed and applied. Thereby, six treatment maneuvers for hc‐BPPV‐ca were simulated: two types of the roll maneuver (the original 270° and the modified 360°) as well as two Gufoni and Zuma maneuvers (for geotropic and apogeotropic nystagmus). Results: The simulations showed that the 360° roll maneuver and Zuma maneuver are effective treatment options for hc‐BPPV‐ca for debris in all locations within the canal. However, the original 270° roll maneuver will not be effective if the clot is in the ampullary arm of the horizontal canal. The Gufoni maneuver for geotropic hc‐BPPV‐ca is effective, whereas for apogeotropic hc‐BPPV‐ca there is a risk of treatment failure due to insufficient repositioning of the debris. Conclusions: The 3D simulations for movement of the otoconia clots can be used to test the mechanism of action and the theoretical efficacy of existing maneuvers for the different BPPV variants. For hc‐BPPV‐ca, the modified 360° roll maneuver and Zuma maneuver are theoretically efficient for all subtypes, whereas Gufoni maneuver is effective for geotropic nystagmus only. [ABSTRACT FROM AUTHOR]

There have been no useful imaging methods to diagnose benign paroxysmal positional vertigo (BPPV), a common cause of vertigo, depending on the characteristic symptom. To visualize horizontal canal (HC) BPPV using 3DCT and assess its clinical usefulness. Ten BPPV patients were diagnosed with distinct BPPV, canalolithiasis, and cupulolithiasis of the HC (hc-BPPV, hc-BPPV-cu), which were definitely diagnosed on the basis of criteria of BPPV by the Barany Society and 10 healthy subjects without a history of dizziness were investigated using 3DCT with several different CT window values (CTWVs). The HCs of BPPV patients were clearly visualized and the luminal aspects showed differences among ears with cupulolithiasis, canalolithiasis and no symptoms healthy subjects. 3DCT images visualized the characteristic changes of the HC of patients with BPPV compared to healthy subjects. The HC images were coincident with the clinical condition of cupulolithiasis and canalolithiasis. This imaging technique is clinically useful for diagnosing, treating and assessing the prognosis of HC BPPV [ABSTRACT FROM AUTHOR]

Background: Migraine, vestibular migraine (VM) and tension-type headache (TTH) are the most common disorders in dizziness and headache clinics, associated with dizziness or vertigo and postural imbalance, causing a substantial burden on the individual and the society. The objective of this research was to examine the presence of spontaneous nystagmus, comorbidity of benign paroxysmal positional vertigo (BPPV), and Tumarkin fall in patients; additionally, the study focused on assessing the patients' responses to bithermal caloric irrigation and video head impulse test (vHIT)., Methods: Consecutive patients diagnosed with migraine, VM, and TTH according to the International Classification of Headache Disorders, third edition (beta version (ICHD-3β)), who were referred to Dizziness and Headache Clinic were enrolled. BPPV and Tumarkin fall were assessed by questionnaires. The presence of BPPV was further evaluated through Dix-Hallpike or head roll maneuver, while spontaneous nystagmus was monitored using video-oculography during interictal period. Lastly, patients' responses to bithermal caloric irrigation and vHIT were analyzed., Results: There was a significantly higher incidence of spontaneous nystagmus in VM compared to both migraine and TTH. The drop attack episodes were slightly more frequent in VM than in TTH and migraine, though not statistically significant. The prevalence of BPPV was significantly higher in VM than in migraine and TTH. Unilateral vestibular paresis was more common in the VM group than in migraine and TTH. There was profound unilateral weakness (UW) in VM patients than in migraine, but no significant difference was found between VM and TTH. In VM, the percentage of saccades along with reduced vHIT gain was significantly higher than in migraine. Lastly, the percentage of abnormal response in vHIT was significantly lower than the percentage of abnormal UW in caloric irrigation across all groups., Conclusions: In VM patients, the prevalences of decompensated peripheral damage and BPPV were higher than in migraine and TTH patients as disclosed by the presence of peripheral spontaneous nystagmus and abnormal vHIT during the interictal period. Our findings suggest that the peripheral vestibular system acts as a significant mechanism in the pathogenesis of VM, and it might also be involved in migraine and TTH cases without vertigo symptoms., Competing Interests: The authors declare no conflict of interest., (Copyright 2024, Zhang et al.)

Objective: This meta-analysis aims to systematically measure the immediate efficacy of the Gufoni maneuver for horizontal canal benign paroxysmal positional vertigo (HC-BPPV).Methods: A extensive search electronic databases, including PubMed, Embase, Web of Science and Cochrane library, were searched until to September 1, 2018 for relevant articles. We selected only randomized clinical trials studying with treatment of HC-BPPV employ by the Gufoni maneuver.Results: Five randomized clinical trials were included in the current meta-analysis with a total of 714 HC-BPPV patients. The meta-analysis revealed that Gufoni maneuver had a higher immediate recovery rate than sham maneuver in treatment of HC-BPPV (risk ratio = 2.68, 95% CI, 1.54-4.65, p < 0.01). No difference was observed in immediate recovery rate between Gufoni maneuver and other maneuvers (risk ratio = 1.18, 95% CI, 0.99-1.41, p = 0.06). And Gufoni maneuver had a similar otolith switch rate with other maneuvers (risk ratio = 2.13, 95% CI, 0.56-8.07, p = 0.27).Conclusion: Gufoni maneuver has a satisfactory immediate efficacy for HC-BPPV and does not increase otolith switch rate. [ABSTRACT FROM AUTHOR]

Objectives: Positional nystagmus can be related to various kinds of disorders. The current study aims to compare the direction-changing horizontal positional nystagmus (DCPN) characteristics in horizontal canal canalolithiasis (HC-canalolithiasis), heavy cupula of the horizontal canal (HC-Hcu), and light cupula of the horizontal canal (HC-Lcu), especially the temporal patterns of positional nystagmus in three disorders. Methods: 52 patients (22 males, 30 females; mean age, 49.6 years) presenting with geotropic or apogeotropic DCPN were enrolled, and they were divided into HC-canalolithiasis, HC-Hcu, or HC-Lcu groups according their nystagmus characteristics. We compared their latency, time constant, peak slow-phase velocity (SPV), time to reach peak SPV intensity (Tpeak), and time to decay to half-peak intensity (T1/2peak). Results: The time to reach peak SPV did not differ significantly between the HC-Hcu (23.1 ± 8.6 s) and HC-Lcu (24.4 ± 9.9 s) groups (p = 0.733), but was significantly longer than that of the HC-canalolithiasis group (5.4 ± 3.5 s; p ≤ 0.001). The peak intensity did not differ among the canalolithiasis (36.4 ± 20.6º/s), HC-Hcu (30.1 ± 23.6º/s), and HC-Lcu (21.4 ± 12.7º/s) groups (p = 0.133). The onset latency also had no statistical difference among three groups (p = 0.200). The nystagmus patterns of HC-Lcu and HC-Hcu groups were similar, including latency, peak SPV intensity, Tpeak, T1/2peak, and SPV in 20 s, 40 s, 60 s, 80 s. Conclusions: The nystagmus characteristics of HC-Hcu and HC-Lcu are similar, except for the fact that movement was in opposite directions, suggesting that HC-Hcu and HC-Lcu may result from a similar pathophysiological mechanism (cupulopathy) differing from that underlying canalolithiasis. [ABSTRACT FROM AUTHOR]

Objective: To identify the Dizziness Handicap Inventory [DHI] scores and items that can be differentiated in benign paroxysmal positional vertigo [BPPV] patients between posterior canal BPPV [PCB] and horizontal canal BPPV [HCB]. Materials and Methods: A prospective cross-sectional study, the study subjects were patients presented at the otolaryngological clinic at HRH Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University, Thailand. The setting was a tertiary otolaryngology practice. The subjects were patients diagnosed with PCB or HCB using the Dix-Hallpike test and the supine roll test. All the patients completed DHI forms at their first visit prior to consultation and at the last visit. All cases were treated with proper maneuver and followed-up until satisfactory clinical improvements and absence of positional induced nystagmus. Results: Sixty-four patients had PCB, 50 had HCB during the study period between April 2015 and March 2017. The average DHI scores for PCB and HCB were 38.91±22.21 and 48.12±19.55 (p-value 0.022), respectively. The p-values of the differences in the average functional items, emotional items, and physical items between both groups were 0.028, 0.061, and 0.026, respectively. Significant difference in the items with p-value <0.01 were item 7 (function, difficulty reading) and 23 (emotion, depression). Significant difference with p-value <0.001 was the combination of item 7 and 23. Conclusion: The DHI scores of BPPV were higher for HCB than PCB. Moreover, the patients with BPPV who had the positive values of items 7 and 23 may provide physicians with clue to look for HCB. [ABSTRACT FROM AUTHOR]

Background: Li quick repositioning maneuver for treatment of geotropic horizontal canal benign paroxysmal positional vertigo (HC-BPPV) was reported in the literature. Objective: The aim of this study is to observe the clinical efficacy of the Li quick repositioning maneuver for the treatment of geotropic HC-BPPV. Methods: The single-blind method was used to conduct a prospective controlled study on 120 patients with geotropic HC-BPPV from May 2014 to May 2017. Patients were randomly assigned to the Li quick repositioning maneuver (Li maneuver) group or the barbecue repositioning maneuver (barbecue maneuver) group. Results: The successful repositioning rates were 53.3%, 70.4%, 90.7% and 92.3%, respectively, in barbecue maneuver group and 61.7%, 80.7%, 93.0% and 96.3%, respectively, in Li maneuver group at 1-day, 3-day, 1-week and 1-month follow-up. Differences in success rates of repositioning between Li and barbecue maneuver groups at 1 day, 3 days, 1 week and 1 month after initial treatment were not statistically significant using the Kaplan-Meier survival curve with a log-rank test (p=.270). Conclusion: The Li maneuver is a rapid, simple and efficacious repositioning method for geotropic HC-BPPV and can be widely applied in clinical practice as an alternative method. [ABSTRACT FROM AUTHOR]

Numerical simulations of flow and heat transfer in a serpentine heat exchanger configuration are presented to demonstrate application of porous media techniques in heat exchanger analyses. In this study, steady-state 3D turbulent forced convection flow and heat transfer characteristics in a rectangular pipe with baffles attached inside pipe have been numerically investigated under constant wall heat flux boundary condition. Numerical study has been carried out for Reynolds number of 20000-50,000, Prandtl number of 0.71, baffle distances h/Dh of 1/3 and 2/3, and baffle thickness e of 1/12, 2/3. It is observed that rectangular pipe having waved baffles has a higher Nusselt number and friction factor compared to the smooth rectangular pipe without baffles. Periodically fully developed conditions are obtained after a certain module. Maximum thermal performance factor is obtained for the baffle waved. Results show that baffle distance, waved porous baffle, and Reynolds number play important role on both flow and heat transfer characteristics. All the numerical results are correlated within accuracy of ±2% and ±2.5% for average Nusselt number and friction factor, respectively. [ABSTRACT FROM AUTHOR]

Conclusions: The co-existence of cupulolithiasis and canalolithiasis might be a possible mechanism for the spontaneous inversion of positional nystagmus. Objective: To investigate the mechanism of spontaneous inversion of nystagmus direction without a positional change in experimental models of co-existing cupulolithiasis and canalolithiasis. Methods: Co-existing canalolithiasis and cupulolithiasis models were prepared using the bullfrog posterior semicircular canal (PSC). Ten bullfrogs were used. The ampullary nerve discharges were recorded as compound action potentials (CAPs). First, an otoconial mass was placed on the cupula to produce cupulolithiasis. Subsequently, another otoconial mass was introduced into the canal lumen to produce canalolithiasis. Decremental time constants for cupulolithiasis and incremental time constants for canalolithiasis were determined. Results: At first the CAPs increased and continued for a long time when the cupulolithiasis was generated. Subsequently the CAPs were suppressed by creating canalolithiasis. Finally, the CAPs increased again after the motion of otoconia inside the canal lumen stopped. The decremental time constant for cupulolithiasis was significantly longer than the incremental time constant for canalolithiasis. [ABSTRACT FROM AUTHOR]

The aim of our study was to assess the outcome of treatment of horizontal canal benign paroxysmal positional vertigo and to analyze the influence of the different prognostic factors on treatment failure. Fifty-nine patients with horizontal canal benign paroxysmal positional vertigo were included in the study. They were divided into two groups according to the treatment protocol, randomly. The first group, after treatment with the barbecue maneuver or inverted Gufoni, depending on the nystagmus form, was instructed to sleep on the side with weaker nystagmus, and the second group did not. In the first group, 88.9% of patients were cured and 91.3% in the second one. There was no significant difference between the two groups. Migraine and the apogeotropic form of nystagmus had a significant effect on treatment outcome, while other variables had no effect.

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Direction changing horizontal positional nystagmus can be observed in a variety of central and peripheral vestibular disorders. We tested sixty subjects with horizontal positional nystagmus and vertigo on the Epley Omniax rotator. Monocular video recordings were performed with the right or left ear down, in the supine and prone positions. Nystagmus slow-phase velocity (SPV) was plotted as a function of time. Thirty-one subjects diagnosed with horizontal canalolithiasis had paroxysmal horizontal geotropic nystagmus with the affected ear down (onset 0.8 ± 1 s, range 0-4.9 s, duration 11.7-47.9 s, peak SPV 79 ± 67°/s). The SPV peaked at 5-20 s and declined to 0 by 60 s; at 40 s from onset, the average SPV was 1.8 % of the peak. Nine subjects diagnosed with cupulolithiasis had persistent apogeotropic horizontal nystagmus (onset 0.7 ± 1.4 s, range 0-4.3 s). Peak SPV was 54.2 ± 31.8°/s and 26.6 ± 12.2°/s with unaffected and affected ears down, respectively. At 40 s, the average SPV had decayed to only 81 % (unaffected ear down) and 65 % (affected ear down) of the peak. Twenty subjects were diagnosed with disorders other than benign positional vertigo (BPV) [vestibular migraine (VM), Ménière's Disease, vestibular schwannoma, unilateral or bilateral peripheral vestibular loss]. Subjects with VM ( n = 13) had persistent geotropic or apogeotropic horizontal nystagmus. On average, at 40 s from nystagmus onset, the SPV was 61 % of the peak. Two patients with Ménière's Disease had persistent apogeotropic horizontal nystagmus; the peak SPV at 40 s ranged between 28.6 and 49.5 % of the peak. Symptomatic horizontal positional nystagmus can be observed in canalolithiasis, cupulolithiasis and diverse central and peripheral vestibulopathies; its temporal and intensity profile could be helpful in the separation of these entities. [ABSTRACT FROM AUTHOR]