Epley’s Maneuver versus Semont’s Maneuver in the Treatment of Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo: A Cohort Study

Abstract

Introduction: Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo in otorhinolaryngological practice. Canalolithiasis and cupulolithiasis are the main theories which describe the pathophysiology of BPPV. Particle repositioning maneuvers are non invasive, simple, bedside procedure that are better tolerated by patients and give symptomatic relief. Aim: To compare the effectiveness of Epley’s vs Semont’s maneuver in the treatment of Posterior Semicircular Canal (PSC) BPPV. Materials and Methods: A cohort study was conducted in Otorhinolaryngology Department of Chettinad Hospital and Research Institute from October 2020-March 2021. A total of 108 patients who reported to the outpatient department and were diagnosed with PSC BPPV were included in this study. A detailed clinical history was recorded audio vestibular examination was conducted and Dix-Hallpike maneuver were performed to confirm the diagnosis. Following which, patients were subjected to treatment with either Epley’s maneuver or Semont’s maneuver. A total of 54 patients were treated with Epley’s maneuver and 54 patients were treated with Semont’s maneuver. Patients were followed-up one week after performing the maneuver. In case of presence of persistent symptoms, the maneuver was repeated upto a maximum of three times. Successful treatment was assessed based upon the patient’s symptomatic improvement of vertigo and a negative Dix-Hallpike test which was performed at the follow-up. Data was presented in proportion (descriptive statistics) and chi-square test was used. The p-value <0.05 was considered as statistically significant. Results: In a total of 108 cases, the most common age group affected by BPPV was that of 21-40 years. Left side BPPV was noted in 50 (46.3%) patients, right side BPPV in 48 (44.4%) patients and 10 (9.3%) patients were found to have bilateral BPPV. Fifty two patients responded well for Epley’s maneuver and had complete resolution of symptoms on first follow-up and 46 patients responded to Semont’s maneuver and improved symptomatically. Conclusion: Greater number of patients improved symptomatically in the first visit itself with Epley’s maneuver compared to Semont’s maneuver. Hence, Epley’s maneuver is the preferred initial treatment and effective modality for PSC BPPV.