A patient with vertigo presents with short-duration, upbeating nystagmus with left torsion during the Dix-Hallpike test. Which intervention is MOST appropriate?

• A. Liberatory maneuver to the left
• B. Liberatory maneuver to the right
• C. Canalith repositioning to the left
• D. Canalith repositioning to the right

Answer: (B)

Interpret the eye movements from Dix-Hallpike as a map to the affected canal. An upbeating nystagmus with a torsional component toward the left ear points to involvement of the left posterior semicircular canal. The goal of treatment is to move the loose otoconia out of that canal and into the utricle. The Semont liberatory maneuver accomplishes this by first placing the patient on the unaffected side, then rapidly moving to the affected side, which helps dislodge the debris and clear the canal. Since the left posterior canal is affected, starting the liberatory maneuver by lying on the right (the unaffected side) is the correct approach, hence the choice of liberatory maneuver to the right.