HYPOTHESIS AND THEORY article
Front. Neurol.
Sec. Neuro-Otology
This article is part of the Research TopicAcute Vertigo and ImbalanceView all articles
Hemi-precession maneuver to treat horizontal canal benign paroxysmal positional vertigo when the affected side is unilateral, bilateral or unknown
Provisionally accepted
- University of Chicago Medicine, Chicago, United States
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Benign paroxysmal positional vertigo (BPPV) is the most common cause of dizziness over the lifespan. The second most commonly affected semicircular canal in BPPV is the horizontal canal, which poses a diagnostic problem and two therapeutic problems. The diagnostic problem is the difficulty of determining the affected side(s) with confidence. This diagnostic uncertainly leads to the first therapeutic problem, which is that one may not know which side to treat. The second therapeutic problem is that because of the approximately coplanar configuration of the horizontal canals, most maneuvers that move otoliths on one side toward the utricle (which is desirable) will also move otoliths on the other side toward the ampulla (which is undesirable) — thus treatment of a given side will "undo" whatever might have been accomplished on the opposite side. Rather than working on the diagnostic dilemma, in this paper we focus on the therapeutic problems by devising a maneuver that leverages the vertical asymmetry of the horizontal canals in order to treat both sides simultaneously.
Keywords: Anatomy, benign paroxysmal positional vertigo, labyrinth, simulation, Treatment, vestibular system
Received: 16 Nov 2025; Accepted: 11 Dec 2025.
Copyright: © 2025 Cherchi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Marcello Cherchi
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.