A 65-year-old man presents with sudden onset severe vertigo when he rolls over to his right side in bed. The vertigo lasts about 15 seconds and then resolves. Dix-Hallpike testing with the right ear down produces characteristic upbeat-torsional nystagmus with the top pole of the eye beating toward the affected (right) ear. What is the most effective treatment manoeuvre?

• A Semont liberatory manoeuvre for the left posterior canal
• B Brandt-Daroff exercises for bilateral canal involvement
• C Barbecue (log roll) manoeuvre for the right horizontal canal
• D Epley (canalith repositioning) manoeuvre for the right posterior canal ✓

Explanation

The Dix-Hallpike test positive with right ear down, showing upbeat-torsional nystagmus with upper pole beating toward the right ear, is diagnostic of right posterior semicircular canal BPPV (canalolithiasis). The Epley manoeuvre (canalith repositioning) moves the otoconia from the posterior canal back to the utricle through a series of four head position changes. It is the most effective single-session treatment with success rates of 80-90%. The barbecue roll is used for horizontal canal BPPV.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.