BPPV is the most common cause of dizziness across the lifespan. Fortunately it is usually straight forward to treat. At times it can, however, be a bit tricky, especially if it involves the lateral canal. According to 2017 Clinical Practice Guideline for BPPV 5-15% of the time the lateral canal is involved. When the lateral canal is involved there are several treatment options. One of the newer ones being the Zuma maneuver.
Over the years I have become pretty comfortable treating lateral canal BPPV. I like using the BBQ Roll if canalithiasis is involved. If cupulolithiasis is involved I like using the Head Shake Maneuver. I will then follow it up with the BBQ Roll, if needed.
These are my "Go To" maneuvers. Then, a few months back, while doing a webinar on treating the lateral canal I was asked by an attendee if had heard of the Zuma Maneuver. My honest response was that I had seen the name come across my path, but had next to no idea what it was. To be honest, not being able to provide some feedback to that question was a bit unsettling. Then, when at the ICVR in Minneapolis a couple of weeks later there was a presenter named Dr. F. Zuma who talked about the Zuma Maneuver. A YouTube video of a similar presentation he gave can be found here.
In my mind, if something comes across my path multiple times in a short period of time, it is usually a sign that I should look into it. So, this blog is a summary of my findings.
The Zuma Maneuver can be considered both a canalith repositioning and a liberatory maneuver as it can be used to treat both canalithiasis and cupulolithiasis of the lateral canal. I think of it similar to the Semont Maneuver as it can treat both canalithiasis and cupulolithiasis of the posterior canal.
Start position: Patient sits with their legs over the side of the examination table. The practitioner holds onto both sides of the patient’s head, while the patient holds onto the practitioner’s forearms
Step #1: Lay the patient quickly onto the side of the affected ear, then wait 3 minutes.
Step #2: Have the patient quickly turn their head 90o away from the affected ear so their nose is now pointing up. Personally, I just have them roll onto their back. Wait 3 minutes in this position.
Step #3: Have the patient quickly turn their head 90o away from the affected ear. They should now be looking over the shoulder of the unaffected ear. Wait 3 minutes in this position.
Step #4: Tuck the patient’s chin in slightly, then have them slowly sit up.
Then you can assess the effects of the treatment with tests such as the Roll, Bow & Lean, and Sit to Supine tests.
Since the original publication there has been a modification to the maneuver.
According to Ramos in 2021, the modified Zuma is different from the original Zuma Maneuver as:
As we review in the YouTube video, the Modified Zuma Maneuver may be better suited to treat lateral canal BPPV when geotropic nystagmus is observed. The original Zuma Maneuver can treat lateral canal BPPV presenting with both geotropic and ageotroppic nystagmus. It may, however, be better suited to treat lateral canal BPPV when ageotropic nystagmus is observed.
The Zuma & Modified Zuma Maneuvers appear to be effective options to treat BPPV affecting the lateral canal. There are, however, other maneuvers such as the BBQ Roll, Appiani/Gufoni, Li, Kim, Head Shake, Modified Brandt-Daroff and Modified Casani that work as well. All of these are outlined in our A Field Guide to BPPV online course.
Personally, if it’s canalithiais, the BBQ Roll remains my “Go To”, as does the Head Shake followed by the BBQ Roll for cupuloliasis. Both have worked for me time and time again. That being said, the Zuma maneuvers may prove more helpful in certain situations, such as if a patient is unable to roll onto their stomach.
If you would like to learn more about BPPV, feel free to check out our website to see the educational opportunities North 49 provides for online and in-person training.
Also, check out our Dizziness Quiz. Based on your quiz results we recommend courses that we have personally taken that have helped us in our journey to understand BPPV better.