Physical therapy for posterior semicircular cupulolithiasis: A case series of 15 patients from South Rajasthan

Abstract Background: Posterior semicircular canal cupulolithiasis (PSC-BPPV- cu ), characterized by otoconial debris adhering to cupula, is a resistant subtype of benign paroxysmal positional vertigo (BPPV) with limited treatment options. Maneuvers like Epley and Semont show low efficacy, necessitating specialized interventions. Objective: To evaluate the efficacy of mastoid oscillations (MO) and/or Bascule maneuver (BM) in treating PSC-BPPV- cu in 15 patients at a South Rajasthan otoneurology center from January 2024 to February 2025. Methods: This retrospective study included 15 patients diagnosed with PSC-BPPV- cu based on Barany Society criteria, augmented by inversion tests and null plane identification. Treatments involved MO in the release position (using a Hitachi Magic Wand at 5,000–6,000 RPM for 15 seconds, three sessions at 15-minute intervals) and/or BM (up to six sessions over 1–3 days). Outcomes were assessed via positional retests at 1 and 24 hours, with weekly follow-up for four weeks. Results: Of 15 patients (80% female, median age 57 years), MO alone resolved symptoms in 3 (20%) within 1 hour, BM alone in 1 (6.7%) within 1 hour, and MO followed by BM in 10 (66.7%) within 24 hours. One patient achieved resolution by one month. At 24 hours, 14 (93.3%) were asymptomatic, and all 15 (100%) remained symptom-free at one month. Canal conversion occurred in 4 patients (26.7%), managed with Gufoni or bow and yaw maneuvers. Conclusion: MO and/or BM achieved a 93.3% success rate within 24 hours for PSC-BPPV-cu, enhanced by precise diagnostic criteria. These interventions offer a highly effective, tolerable approach, surpassing traditional maneuvers.