09-10, 07:30–08:00 (Europe/Istanbul), Equlibirium 1
Purpose: While typical posterior canal (PC)-BPPV is successfully managed with standard repositionings, atypical variants, where otoconia settle in uncommon/stenotic canal tracts generating unusual positional nystagmus, are usually refractory and their management is still debated. They include PCcupulolithiasis, apogeotropic PC-BPPV, sitting-up vertigo and PC-canalith jam. Impulsive maneuvers might be beneficial. While Brandt-Daroff exercises aim to disperse debris using random rotations, we designed a tailored impulsive maneuver along the affected canal plane (LARP or RALP), aiming to treat these variants or to convert them in typical forms, thus allowing to localize otoconia in uncertain cases. Methods: Once placed the patient in the 1st (45°-face-up on the affected side) and then in the 2nd Semont position (45°-face-down on the healthy side), he is then briskly and repeatedly “basculed” side-to-side in a pendular fashion (up-to 5 times per session) with the same head direction (along the LARP or RALP plane) until variation or receding of positional nystagmus. 127 patients (33 males, 94 females, mean age 61.9±12.4 years) with atypical PC-BPPV or anterior canal (AC)-BPPV were prospectively “basculed” along the LARP (75 cases) and RALP (52 cases) planes. 42 subjects had PC-cupulolithiasis, 35 apogeotropic PC-BPPV, 35 sitting-up vertigo, 9 refractory PC-BPPV, 3 canalith jam and 3 AC-BPPV. Results: BPPV directly resolved in 44 cases, while it converted into a typical variant in 63 cases (PC-BPPV in 38, lateral canal-BPPV in 22, AC-BPPV in 3) either in the same session or in the following evaluations, thus allowing to detect the original otolith position in most PC-cupulolithiasis and sitting-up variants (utricular side in 44 cases, long-arm side in 27 cases). In 85% of the remaining uneventful 20 cases, a coexistent ipsilesional vestibular migraine/Meniere’s disease was detected, revealing a possible buoyancy mechanism mimicking atypical PC-BPPV. Conclusions: From our preliminary data, the “bascule maneuver” seems to represent a promising management for atypical PC-BPPV.
2001 - 2008: Medical Degree at the University of Bologna (Italy)
2009 - 2014: Residency with Specialization in Otolaryngology, Head & Neck Surgery at the ENT & Audiology Department of the University of Bologna (Italy)
2014-2015: Research Assistant at the ENT & Audiology Unit of the University of Bologna (Italy)
Since 2015: ENT Consultant involved in medical and surgical activities, dedicated to Neurotology and Vestibular Medicine at the Santa Maria Nuova Hospital, AUSL - IRCCS in Reggio Emilia (Italy)
Since 2020: Head of the Neurotological outpatient clinic at the Santa Maria Nuova Hospital, AUSL - IRCCS in Reggio Emilia (Italy). In collaboration with the Emergency and Neurology Department for the treatment of peripheral and central vestibular syndromes
Since 2021: Advisor of VIS (Società Italiana di Vestibologia), the Italian Society of Vestibular Medicine.
Since 2022: Member of the Barany Society
Course Director of the International online Vestibular Medicine Educational Program
Involved in research activities in the otoneurological field with other national and international Departments and Universities.
Editor for special issues / collections, author of publications (articles and book chapters) in national and international literature, reviewer for ENT/Neurological journals.
Invited speaker in national and international meetings / seminars / webinars