How to Treat Horizontal Canal BPPV (Vertigo) (Gufoni Maneuver)

[@dgross6086]

My wife has had two pretty severe bouts of vertigo. We followed the treatment instructions from this video both times, and they provided instant relief. And by relief, I mean complete resolution of her symptoms. Thank you so much for creating this very helpful video.

[@GordonPhysicalTherapy]

That's awesome! Thank you for sharing that!

[@j1bc]

This giy knows more about understanding and treating vertigo than anyone i have come across 👏

[@suzannewilkinson9091]

Hi! I want to thank you so much for your very clear and concise explanation of the different tests and treatments of BPPV. I was suffering for 3 days with vertigo that didn’t resolve as it usually does with the Epley. Because of you i was able to figure out the horizontal canal issue and treat it properly. Bravo!! Amazing teacher and therapist!! You TRUELY help people when they need it…

[@GordonPhysicalTherapy]

That's so great to hear! Thank you for sharing that with me! I'm happy you were able to figure out the horizontal canal issue and treat it :-)

[@pegbert12]

I remember this way. ABC. A-geotropic, lay on Bad ear, look to Ceiling. Many, many thanks! Life changing procedure.

[@billiefeathers7249]

I’ve had vertigo since I was 18 and am 67 now. Nothing other than meclezine was used and it was really that helpful. In 96 I had severe vertigo for 12 weeks and went through several Epley maneuvers within about 6 months and had to stay upright for 72 hours which was horrible enough if it worked but so defeating if they repeated the procedure after I reported it hadn’t helped . It eventually kind of wore itself out and comes back usually for short periods and I’ve just learned to live with it. Your videos are incredibly educational and it seems like there’s been much improvement in this field. I’m a registered nurse, retired but always ready to learn more so thanks!

[@GordonPhysicalTherapy]

Thank you for sharing your story, Billie! The field has definitely advanced in the last couple decades. I'm sorry you had to struggle with your vertigo for so long! Thank you for your kind words about the video :-)

[@austinb5063]

Hey Luke, I've been watching your videos a bunch to try to help my patients with BPPV. Thanks for all of your content. I thought it was great career development that you made a video 6 years ago about the supine roll test and opted not to make a treatment follow up but a few years later felt confident and ready to explain the treatment side of it. I agree, it's very confusing. But your content has made it much easier to understand. Thank you!

[@chriso3479]

You have no idea how much this helped. A few months ago I developed extreme vertigo and was able to diagnose it as BPPV with help of your videos. It was posterior canal and the issue was solved with a couple of practices of the Epley. Boy, was I sick! Then, a couple of weeks ago, I started feeling a little off balance and lightheaded so tried the Epley again with no results. Yesterday I remembered your saying in some video that sometimes posterior canal BPPV proceeded to horizontal canal BPPV, so I tested for it with the Supine Roll. Although the manifestation was extremely subtle, I could tell, with mirror, I was exhibiting the geotropic nystagmus. It was hardly perceptible but it was there. I did the Gufoni maneuver and it is 99% gone. Today I'll repeat it. Thank you.

[@GordonPhysicalTherapy]

That's awesome to hear! Nice work doing your research and self-treatment!

[@mugdhaapatil552]

And a good trick of triple G’s n triple A’s to help us understand better.. thank you

[@GordonPhysicalTherapy]

Thanks!

[@jeanetterobnargi9136]

Thank you for clearing this up. I’ve been going to PT and getting worse. I don’t believe i was being treated properly. Now I can do it at home.

[@GordonPhysicalTherapy]

You're welcome! Don't be afraid to switch PTs and find one that really specializes in treating vestibular issues like BPPV.

[@glorytogod1750]

EXCELLENT and informative video as usual!! I really wish I lived near your office to be treated for my 3 disc herniations. Thank you for your videos, you have no idea how many people your actually helping!!

[@GordonPhysicalTherapy]

Thank you very much! I appreciate your comments, and I'm happy to hear these videos have been helpful :-)

[@PrabhjotSingh-mn2ku]

Thanks a lot Luke!! After 1 month of successful treatment, my vertigo recurred but this time it was horizontal canal instead of posterior. I struggled for 1 week and thought that it was my left ear this time but after watching your videos, I tested positive for the horizontal canal on the right ear (same ear as before). Did the gufoni and there it was, instant cure!! Thank you so much! And if it helps others, I went through emotional and physical stress both times I got it, I will be managing things better now.

[@GordonPhysicalTherapy]

That's great to hear! You're welcome :-)

[@PrabhjotSingh-mn2ku]

@@GordonPhysicalTherapy post Epley maneuver, it is recommended to not move the head for a couple days. I couldn’t find any such instructions for Gufoni, does that mean that I can start the vestibular exercises straight away?

[@reneel3043]

Thank you so much for this video, I've had a bad flare-up of BPPV. Your videos and explanations are very helpful.

[@GordonPhysicalTherapy]

You're welcome! Glad this helped!

[@christinafoshay6817]

Your videos are extremely helpful and my go-to every time I am trying to fix my husband’s horizontal vertigo. Also appreciate your callouts that the vertigo may shift direction and how to proceed. Thank you!

[@tinot5093]

I did Barbecue roll (Lempert Roll) maneuver to my patient with Geotrophic HC BPPV and it worked. Next time I will do Gufoni if the barbecue roll fails.

[@GordonPhysicalTherapy]

Yes, the BBQ roll usually works very well for geotropic HC BPPV. I like to use the Gufoni because it's easier for patients and just as effective.

[@gss2855]

I really enjoy you're videos. They are very informative....and fairly ez to apply😊

[@GordonPhysicalTherapy]

Thank you so much!

[@mugdhaapatil552]

Thts an amazing trick of triple G’s n triple A’s , to help us understand

[@GordonPhysicalTherapy]

Thank you! I find that kind of thing helpful :-)

[@jayerwin1025]

I had two episodes of vertigo, one in mid January 2024. Three days later I suddenly went double vision. I had dental work and new glasses. The double vision was then only in the evening after computer work. Mid May 2024 I woke up with vertigo. But the vision improved after the Eply move. I found this video and the boat feeling was gone immediately. The vision improved and very little double vision. A round or two of your technique and the eyes correct in focus. Double vision gone.

[@GordonPhysicalTherapy]

That's great to hear! Thank you for sharing your story!

[@newwine2997]

Thank you Gordon. You're a God send You make it easy to understand 🎉👏🎉👏🎉👏🎉

[@GordonPhysicalTherapy]

Thank you! You're quite welcome :-)

[@hadasun]

very clear description and is helpful to me ,your tips are very easy to remember ,thank you ver much

[@GordonPhysicalTherapy]

Glad it was helpful! Thank you for your kind words :-)

[@williamsweeney7954]

Thanks so much. Your videos have been very helpful.

[@GordonPhysicalTherapy]

You're very welcome! Thanks for watching!

[@StomDoth]

If you are having trouble diagnosing which version of horizontal you have, is there any harm in simply doing treatment for both geotropic and Apogeotropic? As a person that lives alone I can't determine which direction my eyes are going.

[@leannejergensen7940]

Extremely good explanation. Thanks so much for sharing.

[@GordonPhysicalTherapy]

Glad it was helpful! You're quite welcome!

[@mugdhaapatil552]

Really loved ur video nice n easy… great job

[@YarnKilla54]

If I could get to WA I'd be fitting myself into your schedule 🤣 You're welcome to come to my house in Michigan 😁

[@GordonPhysicalTherapy]

Why thank you! A trip to Michigan sounds nice, but not until next summer :-)

[@nicolette6327]

Thank you so much for these videos!

[@GordonPhysicalTherapy]

You are so welcome!

[@saurabhgupta5825]

It was so clear.Thank you very much.

[@GordonPhysicalTherapy]

You are welcome!

[@danielleliebsack7619]

I had apogeotropic! My dizziness went away 👀👀👀 I’m in shock. Once I do this maneuver am I done or will I need to do the geotropic maneuver after apogeotripic? I’m scared to do any maneuver again because I feel so good now. I’m not feeling this dizzy anymore but I do feel off. I am still in disbelief because I’ve been dizzy for 5 weeks. I was scared this was my new normal. Thank you so much for this video. I’ve been to two PTs and two doctor visits and ent couldn’t get me in till April and it’s October. I was losing hope.

[@GordonPhysicalTherapy]

This is awesome to hear! If you did the Gufoni and your symptoms are improved, that's an excellent start! Did you retest with the "Supine Roll Test" after you did the Gufoni maneuver? Or have you not retested yet?

[@annabujacz3865]

THANK YOU SOOOO MUCH!!!! It worked like a charm🥰😍🤗

[@GordonPhysicalTherapy]

You're welcome! That's awesome!

[@frankhead593]

about 1 month ago I suddenly got up and suffered from vertigo for 3 days I couldn't move my head. after a week I did the epley and the nystagmus was present in the left posterior canal. I had improvements. after 2 days I did the epley again and I had severe dizziness in the last step of the maneuver. after a few days I tried the horizontal maneuver and for 4 days I had a strange sensation even with my head still. yesterday I tried the horizontal maneuver that you explain and I rotated my head towards the ceiling and it seems to have worked a miracle. I no longer feel that feeling of dizziness and nausea when standing still. A thousand thanks. do you have some advice?

[@GordonPhysicalTherapy]

Glad it worked out for you! My only advice is to make sure you're testing before you treat so you can pick the correct treatment maneuver. If you need me to elaborate on that, just let me know :-)

[@frankhead593]

@@GordonPhysicalTherapy I'm afraid to take the test again. first because the feeling of dizziness was really bad the 2 times I did it and then because I'm afraid that the maneuvers didn't work and having to do them again scares me. I hope that the sensation I feel on the back of my head is due to the fact that I'm doing neck stretching or idk. Thank you 🙏

[@nicholelooby3780]

Hi! I did the Epley with some temp relief , after 2-3 times. But vertigo came back at night. Today I found your video on 2 mistakes to avoid and figured it was horizontal- geotropic. I did the Gufoni maneuver and when I went to check if it helped I got vertigo when laying back with my head straight and didn’t have to turn my head to the left to get it. Should I continue this technique or try a different one?

[@GordonPhysicalTherapy]

I would continue testing and treating as best you can until it's gone. If you have posterior canal BPPV and upbeat/torsional nystagmus, use the Epley. If it switches to horizontal BPPV, use the Gufoni. After each treatment maneuver, wait 5-10 minutes and then test again. Rinse and repeat.

[@nicolefike84]

Is it possible to have only horizontal canal bppv? I have been suffering for going on 6 months now. I've had 5 episodes of vertigo, 4 episodes within a couple months, and another this morning, all presenting with horizontal nystagmus that comes on when turning to my side in bed. Supine and dix-halpike tests always show horizontal nystagmus on the rights side. The strange thing is, I have alot of neck issues that started at the same time. Pain and pressure that started in the right occipital area, and now have pain, stiffness; burning and itching sensations in my neck, and numbness focussed around my right ear into my right occipital, head and down my neck. I'm at a loss and have been to multiple ER's throughout the state of Michigan, and even made a trip to Mayo clinic in Minnesota a couple weeks ago to rile out Neurological possibilities. Any help or info you could give would be greatly appreciated, as I'm reaching the end of my rope.

[@julesbruchez-theartofgrapp9646]

I tested and videos myself and there is little to no eye movement. I definitely have horizontal and have that in the past 3 times. I do have neck and upper issues with overactive muscles But regardless I have to do both Geo and Apo because I can’t figure it out. If I’ve been down or should I say bend over and look down too long then I begin to feel a shift or shaking back-and-forth or maybe a spin just depends If I lay down flat, I’ll always start to feel queasy, but then I’ll settle in if I look to the left after about three seconds I’ll start to spin. It does not do the right side only the left side. But I can look to the left while laying down control the spin stay there for one minute. Retest myself and it goes away. Wake up the next day and it’s right back to where it was at. In the past, I didn’t need any maneuvers. I just needed a lot of massaging and corrective exercise. Other times I did the maneuver once or twice and within two days everything was back to normal this time. I’m going on a 10 day straight up-and-down roller coaster.

[@marcosjimenez2793]

Hello. I have a question. Does it matter if you're having a short sense of falling or having spinning? Im having the sense of falling and wonder if this will work for that?

[@GordonPhysicalTherapy]

That's an interesting question... I don't usually hear BPPV described as the sensation of falling, but if you're having the eye movements (nystagmus) with positional testing, I think it's worth trying to treat. If things don't improve (or they worsen), I would consult with an ENT for additional testing.

[@Angry_Cyclops_781]

Just went through my first experience having BPPV. It was by far one of the worst experiences. Definitely not looking forward to having it happen again but hopefully these movements can be helpful.

[@GordonPhysicalTherapy]

I hope it doesn't happen again too!

[@JAY-qt8bf]

Did it work? I did the epley twice and nothing but I think I have to do this one instead because my eyes are going from right to left but I’m scared 😢

[@hadasavidor]

Thanks for all of your videos on vertigo, they are really helpful. I have bppv vertigo, horizontal, geotropic, right earn more strongly affected. When doing the gofani, should there be spinning and the side to side eye movement? is it beneficial if nothing happens or if there is no spinning maybe i am not in the right position? The supine roll test is positive. We treated it partially sucssefully with the bbq roll a week and half a half ago without really understanding what kind of bbpv it was then. But i am still a little dizzy and would like my life back 😊

[@GordonPhysicalTherapy]

You're welcome! When doing the Gufoni, people usually have a little bit of vertigo and nystagmus, but not much. So don't worry if you don't experience those two while doing the maneuver. Once you can clear the Supine Roll Test, then you'll want to start on some "vestibular exercises". I have one video on that right now, so make sure to check that out!

[@roadcruiser2030]

Hi, I used to get relief from vertigo by using Epley, but it does not seem to be working very well anymore. Suspecting the horizonal canal, but if it is horizontal canal, I don't know which side yet. Is there any harm in doing both versions of the Gufoni, to find the side that is affected by seeing which version works to relieve the dizziness?

[@GordonPhysicalTherapy]

If you can have someone watch your eyes, I'd start with the Supine Roll Test to see if you have horizontal nystagmus. From there, you can certainly try the Gufoni to both sides. The tricky thing with this type of vertigo is determining which version of the Gufoni to do. I hope that makes sense...

[@life-mm5do]

Still feeling like I'm ready to spin just sitting in a chair or sitting up 45 degrees in bed. Earlier had vertigo just lying supine before even getting to the point of the supine check. After I had tested positive for horizontal bppv. Even had this last year. But gufoni isn't working this time.

[@GordonPhysicalTherapy]

I'm a little late in replying to your comment... are you still dealing with this? Or were you able to find some help?

[@HankHill1]

whats your update?

[@geraldhuck2481]

I had a attack Sunday after putting my head forward in the shower. I can not lay down or turn my head without getting dizzy for hours again. It’s now Tuesday and still know not to move wrong & slept sitting up. I’m 70 and have had verdigo for many years. My question is, will the crystal settle eventually settle?

[@GordonPhysicalTherapy]

The crystals rarely "settle" on their own. I recommend finding a PT in your area who can help you with vertigo treatment.

[@jaredlapitan198]

Should I always do the supine maneuver first before going to the gufoni? Or should I straight ahead go with gufoni always when I have checked my symptoms with supine?

[@GordonPhysicalTherapy]

Always check your symptoms with the Supine Roll Test before doing the Gufoni, including in between treatments. This way, you can tell if you vertigo has changed (or if it's gone). I hope that helps!

[@PeterJohns]

Hi Gordon, thanks for spreading the word about HC BPPV. Since I came up with the idea of G = good ear to ground and A = affected ear away from ground I'd appreciate it if you'd make an acknowledgement in your video and perhaps link my video. Thanks.

[@GordonPhysicalTherapy]

I'm not sure I've ever seen your videos, Peter Johns, but feel free to leave a link here. I've watched a lot of videos on BPPV and taken several courses, and G = Good seems to come up a lot.

[@PeterJohns]

@@GordonPhysicalTherapy Pretty sure you won't find a reference to it before my youtube video from October 2017. It was something I came up with to help remember it. kzbin.info/www/bejne/jIPNg4ekftxsj6c

[@justinwong744]

I have the feeling that when I'm lying down on the bed, the bed is moving in random directions and when I sit up right or stand up, the feeling is gone. I had posterior BPPV several months ago and I did Epley maneuver to treat it, I'm not sure if this time it's horizontal canal BPPV.

[@ingadolgilevich1919]

Thanks for your video. Does Barbecue manoeuvre good for ageotropic horizontal canal Bppv?

[@GordonPhysicalTherapy]

BBQ Roll typically works better for geotropic BPPV vs. ageotropic. Also, from everything I've studied, the Gufoni Maneuver works better for both types of vertigo. You just have to figure out which side to treat and which version of the maneuver to use, which I cover in another video.

[@o0ozero0o]

So, my issue is definitely with my right ear. But my eyes don't move in any direction that my partner can see, maybe due to the fact that I have a lazy eye? Is there another way to tell if it's geotropic or apogeotropic, other than eye movement? Or could no eye movement mean it's something other than BPPV?

[@GordonPhysicalTherapy]

Both of your eyes should move if you have BPPV, so you might not actually have BPPV. Have you had a PT or ENT check you out yet?

[@julieconrad5153]

Thanks that was very helpful!

[@GordonPhysicalTherapy]

Glad it was helpful!

[@n8leon]

Thanks for the great videos! My ENT doctor diagnosed me with Left ear Apogeotopic Horizontal Canal BPPV, and the PTs at my healthcare provider confirmed. However, 2 visits to the PT dept with 5 different PT’s working on me, were not able to improve my Vertigo, even after 5 attempts at the Gufoni maneuver, using a massage gun over the mastoid area during the logroll maneuver, and a Kim maneuver. After the massage gun, my vertigo briefly went torsional. However, the Dix-Hallpike maneuver showed I was back to horizontal nystagmus. One other curiosity, I exhibit little-to-no nystagmus on my Left side, moderate in the neutral position, and severe nystagmus on my Right side. Have you seen this before? Any recommendations for proceeding? This is Day 26, so I’m a little desperate.

[@GordonPhysicalTherapy]

It sounds like you're working with a team of PTs who knows what they're doing. Do they have any reason why the treatment isn't working? It sounds like it's been really hard for them to dislodge the otoconia from the cupula. I don't really have any other suggestions...

[@n8leon]

@@GordonPhysicalTherapy they all seemed surprised that the treatments didn't resolve the issue, especially after 2 visits. The more senior PT referred me back to an ENT/Otologist, but doesn't expect he will be able to help, and will have to refer me to a different hospital. Meanwhile, he did give me some exercises to try at home, so maybe that will work over time. Thanks for the reply, much appreciated!

[@sumrandumdood1561]

@@n8leonHas the vertigo subsided? Personally really worried aswell because coming up on my 3rd day with it and mine is the exact opposite of what you explained. Bad nystagmus when looking left and with none looking straight ahead of right

[@n8leon]

@@sumrandumdood1561 yes, between Physical Therapist visits and doing exercises at home, the vertigo finally left, after almost 60 days (yup, 2 months) Much of that time was waiting to see the next specialist. For me, the vertigo was just gone one morning, but after I had seen the PT multiple times, and was doing exercises at home. In the end, we were using "the Kim maneuver" which is similar to the "BBQ roll" but with vibration applied. The first step is proper diagnosis (e.g. which ear and which canal) so that the correct exercise can be done. I would suggest seeing a PT asap. Good luck, I know this is debilitating and miserable!

[@Castus-en7op]

Great video! Can you please clarify if dizziness/ vertigo occurs when bending forward or looking up, turning head in bed one particular side does that point to superior canal BPPV? What is the correct maneuver in that case to apply? I've tried the BBQ maneuver and the Gufoni (Ageothr)on the left side but didn't really work. Many thanks

[@GordonPhysicalTherapy]

Use the "Dix-Halpike" test to determine if you have posterior canal BPPV, and use the "Supine Roll Test" to see if you have horizontal canal BPPV. From there, you can select the appropriate maneuver. Does that help?

[@Castus-en7op]

@@GordonPhysicalTherapy Thank you so much for your advice! I did test for both canals & determined that I had the horizontal canal affected. Carried out the appropriate manoeuvre and it fixed it. It took me another couple of months to completely recover as it did transpire that I had mild concussion.

[@annromero7872]

What kind of vertigo is it when all of a sudden the building in seemsto be falling on you. It only takes seconds though.

[@GordonPhysicalTherapy]

You most likely have BPPV. You still need to know which canal (and which side) it's coming from though.

[@roweebtzr9346]

How many times in a day should i do agetropic gufoni? And how many days Should i do this.? What sleep position should i sleep, like my right ear is the bad ear with agetropic? Please help.

[@GordonPhysicalTherapy]

I recommend doing the Gufoni, waiting 10 minutes, retesting with the Supine Roll Test, and then treating again if needed. Then repeat the same cycle: rest 10 minutes, retest, retreat with Gufoni if needed. Do this up to 4 times in a row each day until your vertigo is gone. Also, when you retest, if your vertigo changed from ageotropic to geotropic, make sure you switch versions of the Gufoni. And if it ever switches to posterior canal vertigo, make sure you switch to the Epley. I know that might sound confusing, but I hope it helps!

[@jencrook4299]

What can I do if I don’t have anyone to look at my eyes? I can easily tell which side is the good and bad ear. So should I just do this on both sides?

[@GordonPhysicalTherapy]

Can you set up a camera or take a video with your phone?

[@hannahshepherd619]

This worked like a charm a few weeks ago! Still get a short sense of falling when I lay on my side. After yoga today (for the first time since my last episode!), I noticed the spinning when laying flat on my back. Any advice?

[@GordonPhysicalTherapy]

Glad it helped! I would retest just to make sure you've completely removed those crystals from the canals and then keep treating if needed. These exercises also help with residual symptoms: kzbin.info/www/bejne/j3uVmaOsiL1nf8U

[@Spiritsearcher101]

If you get it wrong and make it worse will the crystals dissolve on their own in time?

[@JAY-qt8bf]

I tried everything and still nothing, do you have an idea of how much will a visit cost me to a PT if I only have positional vertigo?

[@chrisjennings1384]

What do i do if im getting vertigo only when i tilt my head down,or bend over? Not getting Nystagmus when i do the Dicks Hall Pike,or Supine roll test.No eye movement.Just getting horrible Vertigo when i bend over forward,oor Tilt my head.Not sure how to treat this one.Wandering if im dealing with an upper Cervicogenic issue.If so Any thoughts on how to treat this??? Any maneuvers i could do??Thanks

[@GordonPhysicalTherapy]

Do you get vertigo with the Dix-Halpike test too, or only when bending forward? The sensation of vertigo without nystagmus is still considered a positive test. So you may have BPPV just without the eye movements.

[@chrisjennings1384]

@@GordonPhysicalTherapy Hi there! No Nystagmus with any of those tests. I'm only getting vertigo when I tilt my head, which leads me to believe this may be a C1,C2 cervicogenic issue. Upper Neck really stiff. Only get dizzy when I tilt my head to the side, or down and back up. It only lasts a few seconds but it's there. Been doing some neck stretches and Chin. Tucks seems to be getting better.Thanx!

[@milanekutcher1786]

Which test should you do to start with? Go with the posterior test first? and if nothing then go to Horizontal test? or should you start with the horizontal test as it seems like less movement on the client?

[@GordonPhysicalTherapy]

That’s a great question! I still start with the Dix-Halpike first, mainly out of habit. However, I think it makes more sense to start with the Supine Roll test first, as it’s easily for the client and nice to rule out.

[@milanekutcher1786]

Thank you Dr. Gordon. Your videos are awesome and give a person so much information to feel good about getting treatment. @@GordonPhysicalTherapy

[@michaelchung0003]

If a patient has apogeotropic which side should they sleep on? Also, what should they do after they have done the maneuver?

[@GordonPhysicalTherapy]

Usually I recommend people try to sleep upright after the correcting the BPPV (with the Gufoni Maneuver) for 2-3 nights, or at least sleep with a couple extra pillows. After that, they can return to sleeping on their sides or their back. The key is to correct the BPPV first. Does that help?

[@michaelchung0003]

Yes, thank you.

[@j1bc]

If youve used the Gifoni and youve misdiagnosed could it make you worse?

[@stevenswann2835]

This is super helpful, thank you. I suspect I have the horizontal canal BPPV. If I have no way of diagnosing which side (ie. no-one to watch my eyes), is there any harm in doing both A and G versions of these exercises?

[@GordonPhysicalTherapy]

Hi, Steven. Do you have any way of setting up a video camera so you can watch your own eyes? The only downside to doing both the A and G versions of the Gufoni is that you might undo the good you did with one by doing the other right after. Here's something you might try: start with the geotropic (G) version first and see if that does the trick. Give it a day or so, and if it didn't help, then try the A version. Just an idea :-) Let me know if it helps!

[@stevenswann2835]

@@GordonPhysicalTherapy That's helpful. Thanks for replying - much appreciated.

[@Turk6452]

I have done the Eppley maneuver in the past for my vertigo. I had a couple of instances when I rolled over face down and looked at the floor. The floorboards appeared to be moving for 45 seconds to a minute in the middle part of the exercise. Can you tell me why this happened?

[@GordonPhysicalTherapy]

Assuming you have posterior canal BPPV, which is what the Epley treats, it's a good thing if you experience vertigo in the 3rd position (where you roll to your side with your head down towards the ground). This means that the little crystals have moved in the canal, and hopefully they've moved back out of the canal into the utricle where they belong. Does that explain what you were asking?

[@Turk6452]

@@GordonPhysicalTherapy it does and I really appreciate your responding. It makes me feel confident that the epley maneuver was the right option. Thank you again and have a happy and healthy new year.

[@yessicavelasquez3921]

Hello English is not my fisrt language but I hope you can understand me. I'm a dentist and I have been reading about BPPV for a few months. I made my mom the bbq maneuver as I think she has BPPV horizontal canal geotropic right side. She was 5 days without vertigo but today it came back. My question is: is that normal? should I try the same maneuver or change it. Thank you very much.

[@GordonPhysicalTherapy]

If the BBQ worked the first time, then yes, try it again, as long as the vertigo hasn't changed in terms of the side and the direction. However, if anything changed when you check her with the Supine Roll Test, then be prepared to switch your treatment approach. Also, the Gufoni is easier to perform than the BBQ and typically yields better results. So you might consider that as well. Good luck!

[@nicobay4512]

I keep doing epley and semont maneauver but i still have something in my left ear . If i do the test , lay on my bed and turn my head to the left , i got a intense but verry short nystagmus and vertigo. When doing epley , i go vertigo when i lay with head turn to the left , nothing when i tilt to the right, nothing whe i roll and look down , and intense but short vertigo again whe i sit back . Always feel like my left ear is moist and hot also. When i see my doctor he always make me do the semont , lay on my left with head looking up then quickly move to the right side . But after after more than 1 year of doing that , i start to doubt him

[@GordonPhysicalTherapy]

Are you sure that you have posterior canal BPPV and not horizontal? What does your nystagmus look like?

[@nicobay4512]

@@GordonPhysicalTherapy sorry for double post on 2 of your video . well its a verry short eye move . that go from left to right and a lil up when eyes return to the middle . im trying to see another vestibular doctor but until then , im not sur if i should keep doing the semont or epley or try something else . thk for taking time for giving me advice , i apreciate

[@Dremist]

It is normal to feel dizzy when I am doing the apogeotropic side? after completing I still feel dizzy.. do I continue to do until I dont feel dizzy anymore?

[@GordonPhysicalTherapy]

Yes, you'll often still feel dizzy and have to treat with the Gufoni multiple times. Here's what I recommend: treat with the Gufoni, wait 10 minutes, test again with the Supine Roll Test, then treat again with the Gufoni and repeat as needed (up to 4 times/day until things resolve). Always re-test with the Supine Roll Test after each Gufoni in case the vertigo changed!

[@youssefb8894]

Hi, What should we do if the crystals are stuck in the cupula and not floating in the canal?

[@GordonPhysicalTherapy]

Keep using the correct version of the Gufoni Maneuver, and go down fast to the side for the initial position. This can help dislodge the crystals. You can also do some head shaking from side to side in sitting, with your head hung forward about 30 degrees, before the Gufoni to try to get the crystals to unstick. I hope that helps! If it works, please let me know!

[@youssefb8894]

Thanks for the reply. I have cupulolithiasis on the posterior canal, but epley or semont doesn't work because the crystals are stuck in the cupula. Shaking the head is not enough. Do you have another treatment or tip to get the crystals out the cupula. Thank you very much!!

[@millietubman2982]

If you do a Gufoni nameuver will it be harmful if it doesn't help to then do the epley?

[@GordonPhysicalTherapy]

Good question! It depends on what the eyes are telling you... if the Gufoni results in torsional nystagmus, then the Epley would be appropriate. However, if you're still dealing with horizontal nystagmus, then you should do the Gufoni again (and make sure you're doing the correct version of the Gufoni).

[@austinpropertygroup]

Can you just do both methods to be safe?

[@GordonPhysicalTherapy]

No, you want to be specific and pick the right method if you can. Otherwise, you run the risk of undoing the positive benefits of the correct maneuver by doing the incorrect maneuver.

[@stts762]

I am not sure which side is bad as i get unbalanced feeling by turning my head left or right Is there any harm if I do the wrong one or just nothing happens ?

[@GordonPhysicalTherapy]

No real harm, no. Although it can very nauseating!

[@stts762]

I was at the ent and they determined it was on the right side but that was more like spinning so not sure where the inbalance comes from The inbalance slowly improoved by iteslf and the doctor did the epley manuver than the next day I did it myself and it was still bad but on the second day it was all good I just have the pattern tinnitus to work on now

[@petr6258]

What if your eyes dont stop moving after holding position for ages?

[@GordonPhysicalTherapy]

That's a good question... if your eyes don't stop moving, the most likely explanation is that you have cupulolithaisis (the crystals are stuck to the cupula). If this is the case, I usually try moving people into the first position more rapidly to dislodge the crystals from the cupula.

[@ScottoGrotto]

Hi Dr Luke, Thanks for these very detailed videos on recognizing, and the appropriate maneuver! I watched a few videos today to help figure out how to help a loved one. I noticed doing the Epley yesterday based on a left side likely problem ( based on left turning started room spin 2x on Friday) side that nystagmus occurred after rotating the head left to right and appeared horizontal. Loved one improved some, Sunday after epley. So today after learning the different nystagmus patterns, watched videos on lempert, gufoni, with a basic recognition of which side to treat. Then I watched your video on how to determine the side. Unfortunately I didn’t watch your how to treat video yet before starting.. With my loved one tried Dix Hallpake, now L neg, and right some horizontal nystagmus. Tried the supine roll test, both sides slight ageo nystagmus a bit more intense on the right. So we did a right side lempert. Which went not quite as well as the epley. ( based on some videos this seemed appropriate, but realized it didn’t go with your opposite side for ageo advice) so went back and tried a typical gufoni for the opposite side. This didn’t go well, kind of made it worse for awhile ;) Now watching your Gufoni video it appears there is an ageo Gufoni! The nystagmus appeared more subtle than yesterday. But any nystagmus with dizziness likely means there are still crystal activity? And if I can convince my loved one to try tomorrow we can do the appropriate ageo Gufoni. After retesting! How long a rest do you recommend before a retest? Do you persist until no nystagmus? Thanks 🙏

[@GordonPhysicalTherapy]

Nice job learning the ins and outs of this stuff! It's pretty confusing, especially with horizontal BPPV... and even more so with ageotropic nystagmus. I usually let people rest for 5-10 minutes after the Gufoni before retesting with the Supine Roll Test. Let me know how things go!

[@ScottoGrotto]

@@GordonPhysicalTherapy Thanks! So grateful for your sharing this level of detail in recognizing the variations of geotropic/ageotropic! And helpful appropriate treatments/maneuvers! My loved one, MLO, after Monday wasn’t sure about my efficacy :) But last evening she allowed me to slip in the R ageo Gufoni as the last of her Brandt exercises. This at first caused a bit more dizziness, which might be a sign that crystals are on the move? Thankfully this morning she dropped down a notch ~ 25% better from a 2 to 1.5!🙏✨ I wasn’t allowed to pre or post test, just went with a R ageo Gufoni per your treatment video, and the testing we did on Monday. Hopefully MLO will allow testing again, and we can help more! An Epley based on left side head turn dizziness last Sunday helped some too. Energetically after both that Epley, and the R Ageo Gufoni, she felt more “stable” “grounded” “settled” to me. And most importantly to her ✨🙏✨

[@jameswerner7955]

does it hurt to treat both ears using GUF treatment?

[@GordonPhysicalTherapy]

It's usually best to just treat one side at a time. And most of the time, only one side is involved.

[@Spiritsearcher101]

What if both sides make you dizzy? I have that. What do i do?

[@GordonPhysicalTherapy]

That's completely normal with horizontal canal testing. Check out my video about "how to diagnose horizontal canal BPPV" and this should help you figure it out.

[@Spiritsearcher101]

Thank you. I tried the test and I think something went wrong. Both sides feel equally bad and when I sat up in really really wavy like I can't move my head at all because it's like I'm moving. Not spinning but every movement of my head side to side or up and down causes false movement. I think the crystals either moved somewhere bad or they're stuck somewhere. I don't know what to do

[@edwin1623]

How many times should the maneuver be completed?

[@GordonPhysicalTherapy]

I perform the maneuver until the vertigo/nystagmus has cleared on the Supine Roll Test. If I can't clear the vertigo in 3-4 rounds, I'll typically try again the next day, just to avoid too much nausea.

[@retsu_shin]

what if you did the wrong exercise. will it get worse. will it get stuck?

[@GordonPhysicalTherapy]

No, not really. If you do the wrong maneuver it just won't help, and doing the maneuver itself might make you a bit nauseous. However, it won't make the underlying condition worse.

[@retsu_shin]

@@GordonPhysicalTherapy FYI I got lucky and did the right maneuver and it's gone now. I asked a medical professional if the crystal will ever get absorbed back in my body but they told me no. I'm just happy that I'm not dizzy anymore I got lucky

[@brendanmalanga2529]

How long does it usually take to work?

[@retsu_shin]

@@brendanmalanga2529 For me once I did the right maneuver it was instant. You need to move the crystals to a part of your ear that isn't bothering you. And for me remember everyone is different, for me I did the maneuvers where my Vertigo would be more intense

[@life-mm5do]

My physical therapist did the gufoni. But he treated both ears. Then I sat up and he had me look at the floor and I started with vertigo again. So then he did the epley maneuver both sides and I had vertigo on the right.

[@GordonPhysicalTherapy]

I'm wondering if you had BPPV on both sides? You'd usually only treat one side at a time, but I'm not sure about your situation...

[@CarlosDiaz-hi2ik]

Excellent presentation! One cavil: I’m a physician, I don’t have “clients”. I have patients. This is a critical distinction. Practicing medicine is not a business transaction. You don’t treat a client like you treat a patient (you don’t do a rectal exam to sell someone a car!); it’s just plain disrespectful to equate those two terms.

[@GordonPhysicalTherapy]

Thank you about the presentation! I actually prefer the term "client" vs. "patient". To me, a client is someone I really care about and have a close relationship with, beyond the provider-patient relationship, which I feel is a little more one-sided and sterile. No rectal exams or car sales, though!

[@CarlosDiaz-hi2ik]

I also really care about my patients, although professionally we have to be careful about “close relationships” with patients!

[@SmarterNonProfitMartie]

Thanks from Germany (;

[@GordonPhysicalTherapy]

You're quite welcome! Never been to Germany... maybe someday :-)

[@mg7693]

What about pts testing themselves at home? Please explain how to do these Dx and the TX. Thank you!

[@GordonPhysicalTherapy]

You can test and treat at home following my videos on BPPV, it's just challenging at times. And it's much easier if you have someone there to help you and to watch your eyes for you, as the direction of the nystagmus helps you figure out what type of vertigo you have and how to treat it.