Yacovino Maneuver
Introduction
In 2009, Yacovino and Hain introduced a maneuver designed to treat anterior canal benign paroxysmal positional vertigo (AC- BPPV). Unlike other repositioning techniques, this maneuver works symmetrically for both anterior canals, regardless of the affected side.[1]
Purpose
The Yacovino maneuver, also known as the Deep Head Hanging maneuver, is a therapeutic technique developed to manage AC-BPPV, a rare subtype of benign paroxysmal positional vertigo (BPPV).AC-BPPV is characterized by brief episodes of vertigo triggered by specific head movements due to dislodged otoconia affecting the anterior semicircular canal.The primary goal of the Yacovino maneuver is to reposition the displaced otoconia from the anterior semicircular canal back into the utricle, thereby alleviating vertigo symptoms.[2][3]
Technique
The Yacovino maneuver involves the following steps:
Starting Position:
The patient sits upright with the head in a neutral position.
Head-Hanging Position:
The patient quickly lies back into a supine position with the head hanging at least 30 degrees below horizontal, supported by the edge of the bed. The patient remains in this position until any induced dizziness subsides, plus an additional 30 seconds.
Chin-to-Chest Position:
While still lying supine, the patient scoots down to place a pillow under the head and then moves the head into a gentle "chin-to-chest" position. This position is maintained until dizziness passes, plus an additional 30 seconds.
Return to Sitting:
Maintaining the "chin-to-chest" position, the patient slowly returns to a sitting posture and remains in this position for 30 seconds.
Final Position:
The patient returns the head to a neutral position and sits with the head level for 15 minutes.[3]
The following video shows how to use the test.
Evidence
Several studies have explored the effectiveness of the Yacovino maneuver in treating anterior canal benign paroxysmal positional vertigo (AC-BPPV). A 2021 study by Bhandari et al. employed three-dimensional simulations to track otoconial debris movement during various repositioning techniques. Their findings confirmed that the Yacovino maneuver is an effective treatment for AC-BPPV, eliminating the need to determine the affected side. However, the study also highlighted a potential risk of canal switch to the posterior semicircular canal, prompting recommendations for a modified Yacovino maneuver to reduce this risk.[2]
Additionally, a 2015 analysis demonstrated that AC-BPPV comprises about 3% of all BPPV cases and can be treated safely using maneuvers such as the Epley and Yacovino maneuvers, with rates of symptom resolution comparable to those reported for other BPPV variants. [5]
These studies provide evidence supporting the use of the Yacovino maneuver in managing AC-BPPV.
References
- ↑ Garaycochea O, Pérez-Fernández N, Manrique-Huarte R. A novel maneuver for diagnosis and treatment of torsional-vertical down beating positioning nystagmus: anterior canal and apogeotropic posterior canal BPPV. Brazilian Journal of Otorhinolaryngology. 2022 Oct 17;88:708-16.
- ↑ 2.0 2.1 Bhandari A, Bhandari R, Kingma H, Strupp M. Diagnostic and therapeutic maneuvers for anterior canal BPPV canalithiasis: three-dimensional simulations. Frontiers in neurology. 2021 Sep 24;12:740599.
- ↑ 3.0 3.1 Umich.edu. Available at: https://www.med.umich.edu/1libr/PMR/Vestibular/AC-YacovinoManeuver(QRcode).pdf (Accessed: February 12, 2025).
- ↑ Youtu.be. Available at: https://youtu.be/WqM3xNjkDqk?si=MobfHfGQkruPO-z8 (Accessed: February 12, 2025).
- ↑ Anagnostou E, Kouzi I, Spengos K. Diagnosis and treatment of anterior-canal benign paroxysmal positional vertigo: a systematic review. Journal of Clinical Neurology. 2015 Jul 1;11(3):262-7.