Deep Head Hanging Maneuver

Benign Paroxysmal Positional Vertigo (BPPV) affecting the anterior semicircular canal (superior canal)
1. Procedure is diagnostic and therapeutic

Patient moves from seated position to lying supine
1. Patient's head should overhang the end of the table
2. Patient should extend their neck as much as possible (at least 30 degrees), so they are looking at the wall behind them
Observe for Downbeat Nystagmus (Vertical Nystagmus) as patient moves into this position
1. Vertical Nystagmus is otherwise a sign of cerebellar lesion (perform a careful Neurologic Exam)
2. Nystagmus may also be torsional toward the affected ear
Maneuver
1. Patient remains supine with neck extended for 3 minutes
2. Next, patient flexes their neck (chin to chest) as much as possible for 3 minutes
Completion
1. Assist the patient back to a seated position