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Physical Therapy Management of a Patient with Anterior Canalithiasis using the Deep Head Hanging Maneuver

Amer Al Saif and Eric G. Johnson

A 61-year-old female patient presented with a chief complaint of chronic vertigo that started suddenly four months ago. Her symptoms included intermittent nausea and position related vertigo. The left Hallpike-Dix test produced the patient’s vertigo and nausea. Weak left torsional downbeat nystagmus of approximately 10 seconds duration was also observed. The straight head hanging (HH) test was subsequently performed and it produced multiple beats of robust left torsional downbeat nystagmus of approximately 30 seconds duration. The patient was diagnosed with left anterior canalithiasis, which is a type of benign paroxysmal positional vertigo (BPPV). The deep head hanging maneuver (DHM) was performed and the patient reported feeling better immediately afterward. The HH test was performed again within a couple of minutes and the patient reported 80% resolution of both her vertigo and nausea. The patient was seen the following day and reported 100% resolution of symptoms. Her symptoms remained resolved at a 1 week follow-up. Based on the limited research concerning the examination and intervention methods described in this single subject case report, further research including controlled clinical trials are needed.