Head Shaking Maneuver for Horizontal Semicircular Cupulolithiasis

Head shaking maneuver (HSM) is performed with the patient in short-sitting and lower limbs hanging along the long edge of the examination table. The head is anteflexed 30-degrees in the pitch plane and briskly shaken by the excursions of 30-degrees side-to-side at an approximate rate of 3 Hz in the yaw axis for around 30-seconds. The treatment options for the horizontal semicircular cupulolithiasis are not very established. HSM can result in immediate resolution of positional vertigo and nystagmus if the otoconial debris is adherent to the utricular side of the cupula (Cup-U). On the contrary, in the Cup-C variant of the horizontal semicircular cupulolithiasis, the otoconial debris getting detached by HSM is relocated in the horizontal semicircular canal either in its short anterior (ampullary) arm or the long posterior (nonampullary) arm; thereupon transformation to either geotropic long posterior (nonampullary) arm horizontal semicircular canalolithiasis or the apogeotropic short anterior ampullary arm canalolithiasis occurs.

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