Blockages in the canal that keep particles from exiting with maneuvers are very rare, fewer than 1 in 100 cases of BPPV. We don’t yet know exactly how rare it is. However, these rare cases can still be treated with maneuvers. Some modifications are needed to get the particles past the blockage.
First, it is always necessary to apply vibration to the skull behind the ear. This can be done by tapping behind the ear, or by placing an ordinary vibrator used for muscle massage there. The vibration needs to be applied throughout the maneuver used for treatment. Although the otoconia are very sticky, they can be separated by vibration. For example, when pouring sugar through a funnel, it can become jammed up in the narrow part, but this can be corrected by tapping or shaking the funnel. The same thing works for otoconia that are jammed.
The Gufoni maneuver is the best one to use during the vibration. Because the particles are deep in the canal, a small modification is needed. One of the first steps of the Gufoni maneuver is to lie on your “good” side with the “bad” ear up. If a jam is present, you will still lie on the good side, but your head needs to be turned toward the shoulder on the “bad” side, so that your face is looking straight up at the ceiling. Vibration here allows particles to move slowly toward the exit. After 15 seconds or so, turn your head toward the normal side, continuing the head turn until your face is looking straight down at the bed.
It may take several repetitions to break up a jam. Since H-BPPV is very nauseating, it’s a good idea to use over-the-counter motion sickness meds to help keep your stomach settled. Some people simply can’t do this to themselves comfortably, so this kind of BPPV is often best treated by professionals.
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