Optimization of the Yacovino maneuver for superior canal BPPV using numerical simulations

We evaluated the effectiveness of the original Yacovino maneuver (YM) for treating superior canal benign paroxysmal positional vertigo (SC-BPPV) using numerical simulations and proposed modifications to enhance its efficacy. A high-resolution three-dimensional micro-computed tomography (μCT) reconstruction of a human membranous labyrinth was used to simulate the BPPV condition. Endolymphatic fluid dynamics were modeled by solving the Navier-Stokes equations, and otoconia of varying sizes (3-30 µm) were introduced as Lagrangian particles. Their displacement was tracked using a superior canal-centric polar coordinate system. Two maneuver protocols were simulated: the original YM and a modified version with adjusted rotational angles and a 30-second resting interval per step. The original YM resulted in otoconia trapping in the ampulla and canal switching, limiting its effectiveness. In contrast, the modified YM-in which the patient lies face down with a 50° head flexion in the initial step, followed by optimized subsequent rotations-significantly improved otoconia migration toward the utricular macula. Longer resting times further enhanced the displacement of smaller particles without compromising maneuver safety. These findings suggest that the modified YM is a safe and effective alternative for SC-BPPV treatment. Tailoring rotation angles based on anatomical variability may improve outcomes, though clinical validation is still required.