Semont Maneuver Research Articles

Management Protocol for the Unilateral Posterior Canal - Benign Paroxysmal Positional Vertigo - A Prospective Observational Study.

The objectives of our study were to assess the effectiveness of the single Epley manoeuvre per session for three consecutive days and to determine the protocol for treating posterior canal-Benign Paroxysmal Positional Vertigo (pc-BPPV). At our tertiary care centre, 410 patients with a confirmed diagnosis of unilateral pc-BPPV were included in a prospective observational study. For all the participants, the Epley manoeuvre was performed once daily for three consecutive days. Patients with persistent vertigo underwent Semont's liberatory manoeuvre and were reassessed after one week. The above protocol was repeated for patients who continued to have symptoms. The majority (40.0%) of patients were seen in the 6th decade, followed by the 5th decade (34.4%). Among the study participants, the mean age was 51.57 ± 9.916 years. The male-to-female ratio is 1:1.05. The right ear was affected by 51.75%, and the left by 48.3%. With this protocol, 392 (95.6%) patients were relieved of symptoms by day 3. A six-month recovery rate of 99.75% was achieved. In our study, 99.8% of patients with unilateral pc-BPPV were cured, and 6.34% had a recurrence of symptoms within six months of follow-up. Hence, combining the Epley and the Semont manoeuvres and repeating the manoeuvres on consecutive days has better improvement.

A Comparison of the Efficacy of Four Repositioning Maneuvers in the Treatment of Posterior Benign Paroxysmal Positional Vertigo.

The purpose of the present review was to report the effectiveness of Epley maneuver compared to other manual repositioning maneuvers (RM) for treatment of posterior benign paroxysmal positional vertigo (P-BPPV). A systematic search of PubMed, Embase, and the Cochrane Library was conducted up until June 30, 2023. Primary outcomes focused on complete resolution of vertiginous symptoms measured by either a Visual Analog Scale (VAS) or the Dix-Hallpike (DH) test. Secondary outcomes included conversion of a positive DH test to a negative DH test exclusively looking at positional nystagmus and assessment of side effects (cervical/back pain, posttreatment dizziness, and nausea). Both outcomes were assessed within a maximum of 4-week follow-up. Following systematic search and review, nine randomized controlled trials (RCTs; p = .413) were found. The studies reported on the effectiveness of the Epley maneuver compared to three other specific RM: Semont, Li, and Gans maneuvers. Results revealed a low to very low certainty of evidence. With the primary outcomes, Epley maneuver was superior to Gans maneuver 24-hr posttreatment but not after 1 week. No significant differences were found between the remaining maneuvers. In summary, evidence of low to very low certainty indicates that Epley maneuver is comparable with Semont, Gans, and Li maneuvers for vertiginous symptoms in patients with P-BPPV. Further high-quality studies are needed.

Epley's Manoeuvre vs. Semont's Maneuver in Post-Canal Benign Paroxysmal Positional Vertigo: A Comparative Study in a Tertiary Centre.

This was a prospective, comparative study conducted at a tertiary care hospital. One hundred patients diagnosed with post-canal BPPV were randomized into two groups: Group A (n = 50) underwent the Epley's manoeuvre, and Group B (n = 50) underwent the Semont's manoeuvre. The patients were assessed for the resolution of vertigo and nystagmus immediately after the manoeuvre and at a follow-up visit one week later. The resolution of symptoms was confirmed through Dix-Hallpike test. In Group A, 46 patients (92%) reported complete resolution of vertigo immediately after Epley's manoeuvre, and 47 patients (94%) had no nystagmus on the Dix-Hallpike test at the one-week follow-up. In Group B, 42 patients (84%) reported complete resolution of vertigo immediately after Semont's manoeuvre, and 44 patients (88%) had no nystagmus on the DH test at the one-week follow-up. The difference in effectiveness between the two manoeuvres was not statistically significant (p > 0.05). Both Epley's manoeuvre and Semont's manoeuvre are effective in treating post-canal BPPV, with similar success rates. The choice of manoeuvre may depend on patient preference, clinician expertise, and other individual factors. Further studies with larger sample sizes are warranted to validate these findings and explore other potential factors influencing the outcomes of canalith repositioning manoeuvres in BPPV.

To compare the recovery rates of modified Epley's against Semont's manoeuvres in patients with posterior canal benign paroxysmal positional vertigo: a randomized clinical trial.

Benign paroxysmal positional vertigo (BPPV) is one of the commonest causes of peripheral vertigo. It is treated with various canalolith repositioning manoeuvres by changing the head positions to allow the otoconial debris to fall back from the affected canal back to the utricle. The present study has compared the rate of recovery of vertigo with modified Epley's manoeuvres as compared to Semont's manoeuvre in patients with posterior canal BPPV. One hundred and seventy patients diagnosed by positive Dix-Hallpike test as posterior canal BPPV were included in this clinical trial. Subjective analysis of vertigo was done using visual analogue scale. 85 patients each were recruited in two arms by simple randomization using lottery method. Modified Epley's manoeuvre was administered to one group and Semont's manoeuvre to the other. They were recalled after 2weeks for clinical assessment with repeat Dix-Hallpike and VAS. Repeat Dix-Hallpike manoeuvres after two weeks revealed that 95.3 and 90.6% patients improved in Modified Epley's and Semont's group, respectively. After the second manoeuvre, the resolution rate was significantly higher in Semont's manoeuvre 100% (8 out of 8 patients), as compared to 25% (1 out of 4 patients) in Modified Epley's manoeuvre. Comparison of the mean values of VAS day 0 and VAS 2 weeks has been found to be statistically significant (p value of < 0.001). Both Epley's and Semont's manoeuvre are equally efficacious in treatment of BPPV. However, use of Semont's manoeuvre required fewer repeat manoeuvres for complete resolution of symptoms in patients. The Semont's manoeuvre is also comparatively easier to perform with less number of position changes, takes less time, and has no requirement of post-manoeuvre mobility restrictions. Hence, it is recommended that Semont's manoeuvre can be routinely used for the management of PC BPPV especially in older population and patients with spinal problems.

Semont maneuver for posterior canal benign paroxysmal positional vertigo: a systematic review of randomized controlled trials.

This review aimed to examine the effects of the Semont maneuver on posterior canal benign paroxysmal positional vertigo (BPPV). PubMed, PEDro, SCOPUS, REHABDATA, EMBASE, and Web of Science were searched comprehensively from inception to January 2024. The Physiotherapy Evidence Database (PEDro) scale was employed to evaluate the quality of the selected studies. In total, 18 randomized controlled trials met the eligibility criteria. A total of 2237 participants with BPPV (mean age = 58.10years) were included in this review. Among them, 37.5% were males, and 58% presented with right-sided BPPV. The included studies ranked from 5 to 9 out of 10 (Median = 7), suggesting good to excellent quality on the PEDro scale. The available literature revealed that the Semont maneuver is effective in improving posterior canal BPPV symptoms. The Semont maneuver is considered a standard option for treating posterior canal BPPV, with a high success rate of around 80%. It is suggested as the primary option for managing posterior canal BPPV in individuals who complain of cervical or lumbar problems, severe cardiac or respiratory conditions. Further studies are strongly needed to understand the long-term effects of the Semont maneuver and to identify the recurrence rate.

Effectiveness of brandt-daroff exercises in the treatment of benign paroxysmal positional vertigo: a systematic review of randomized controlled trials.

This review aims to examine the effects of Brandt-Daroff exercises (BDEs) on individuals with posterior canal Benign Paroxysmal Positional Vertigo (BPPV) and to provide recommendations for future research on this topic. PubMed, MEDLINE, PEDro, SCOPUS, REHABDATA, EMBASE, and Web of Science were searched from inception to November 2023. The Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of the included studies. In total, ten randomized controlled trials met our eligibility criteria. A total of 880 individuals with BPPV (63.6% females) were included in this review. The included studies were ranked "good quality" on the PEDro scale. The available literature showed that BDEs do not significantly reduce symptoms or promote recovery in people with posterior canal BPPV compared to other interventions, such as Epley and Semont maneuvers. The evidence for the effects of BDEs on patients with BPPV is limited. Further high-quality studies with long-term follow-ups are strongly required to investigate the long-term effects of BDEs in posterior canal BPPV, define the optimal application of BDEs, and identify the factors associated with treatment response and recovery.

Clinical Efficacy and Metabolomics Modifications Induced by Polyphenol Compound Supplementation in the Treatment of Residual Dizziness following Semont Maneuver in Benign Paroxysmal Positional Vertigo (BPPV) of the Posterior Semicircular Canal (PSC): Preliminary Results.

Benign paroxysmal positional vertigo (BPPV) represents the most frequent cause of peripheral vertigo. In most cases, it is successfully treated using the canalith repositioning procedure, but it is often followed by continuous lightheadedness in the absence of vertigo or nystagmus (residual dizziness, RD). Our aim is to describe the clinical effectiveness and the urine metabolomics profile of treating these patients with polyphenol compound supplementation. We enrolled 30 patients reporting RD after BPPV of the posterior semicircular canal (PSC) successfully treated using the Semont maneuver. Supplementation with a polyphenol compound was administered for 60 days, and patients were evaluated after 30 and 60 days of treatment using self-administered questionnaires (Visual Analog Scales for Dizziness and Nausea, Dizziness Handicap Inventory, DHI) and urine metabolomics analysis performed using 1H-NMR spectroscopy and multivariate followed by univariate analysis. Most patients reported excellent or good efficacy in the treatment of RD with a significant decrease in VAS and DHI values. The metabolomics analysis identified six significant metabolites related to the treatment, namely 1-methylnicotinamide, anserine, hippurate, lysine, methyl succinate and urea, indicating the inflammatory activities and antioxidant properties of the polyphenol compound. These preliminary data suggest that supplementation with a polyphenol compound could induce some metabolic changes that can help in recovery from RD. However, future steps will require confirmation with a more significant cohort of patients and an extension of the metabolomics evaluation to other problems concerning the different clinical aspects of BPPV, such as the high rate of relapse.

Treatment of posterior Benign Paroxysmal Positional Vertigo is efficient and safe with a new Mechanical Rotational Chair.

Benign paroxysmal positional vertigo (BPPV) is the most predominant vestibular disease. Previously, in the management of BPPV, both therapeutic and diagnostic benefits with mechanical rotation chairs (MRCs) have been reported. However, no previous studies have examined the efficacy of MRC treatment with a fairly new MRC. Randomized three-armed parallel open-labeled prospective clinical trial. One hundred and five patients diagnosed with posterior BPPV underwent diagnostics and treatment with an MRC. Patients were randomized to either a Semont maneuver, an Epley maneuver or a 360-degree backwards somersault maneuver. Primary endpoint was to evaluate the efficiency of an MRC in the treatment of posterior BPPV with three separate treatment modalities. Secondary objectives included subjective vertigo assessments. BPPV treatment with this MRC is very efficient with success rates up to 97.1 percent. The number of treatments required to achieve complete resolution of both objective findings and subjective symptoms was 1.5. Almost 47 percent of patients experienced complete resolution of both subjective and objective measures following one (first) treatment. All Dizziness Handicap Inventory scores decreased significantly post-treatment. Treatment of posterior BPPV, with the MRC used in this study, was very efficient with both the Semont, the Epley, and the 360-degree backwards somersault maneuver. Based on the findings in this study, this fairly new MRC seems both effective and safe to use.

Comparative Efficacy of Epley, Semont and Gans Maneuver in Treating Posterior Canal Benign Paroxysmal Positional Vertigo.

Pharmacological therapies are used to control Benign paroxysmal positional vertigo (BPPV) symptoms for a brief period, discontinuing them usually results in recurrence. Canalolith repositioning maneuvers, including Epley, Semont, and Gans maneuvers, have been recommended for treating posterior canalBPPV with a high rate of success. A prospective, quasi-randomized study was carried out to compare the efficacy of Epley, Semont, and Gans maneuvers in the treatment of posterior canal BPPV and their durability. All patients over the age of 20 who met the BPPV diagnostic criteria, regardless of gender, were included in the study. Diagnosis of BPPV was done by Dix Hallpike maneuver. Typical posterior canal BPPV, the most frequent form of BPPV, is characterized by paroxysmal nystagmus evoked through the Dix-Hallpike test; the nystagmus is torsional clockwise for the left side, counter-clockwise for the right side, with a vertical up-beating component. The patients were uniformly quasi-randomized in a 1:1:1 ratio to be treated with Epley, Semont, and Gans maneuvers. After performing the maneuver, the patients were again subjected to the Dix-Hallpike test. Based on the result of the Dix-Hallpike test's positivity, the maneuvers were repeated up to three times. All the patients were called for a reassessment 30days after the last intervention to assess the durability of the maneuver. In the study, 54.44% (49) of the 90 patients were female, whereas 45.56% (41) were male. Overall, 83.33% (75) of patients required only one attempt, 15.56% (14) required two attempts, and 1.11% (1) required three attempts to improve. In the Epley maneuvers group, 86.66% (26) required only one attempt, 10% (3) required two attempts, and 3.33% (1) required three attempts. Similarly, 83.33% (25) required only one attempt in the Gans maneuvers group, and 16.67% (5) required two attempts. In Semont maneuver groups, 80% (24) required only one attempt, and 20% (6) required two attempts. The recurrence of the symptoms was seen in a total of 11 patients: 27.27% (3 patients) of the Epley maneuvers group, 36.36% (4 patients) of the Gans maneuvers group, and 36.36% (4 patients) of the Semont maneuvers group. All three maneuvers show equal efficacy in reducing vertigo. The Epley maneuver may be more relevant in the treatment of BPPV compared to others, considering the slightly higher improvement rate and the requirement for fewer attempts for the treatment.

Comparing Efficiency Epley and Semont Manoeuvre with Videonystagmography.

The online version contains supplementary material available at 10.1007/s12070-023-03901-3.

Effect of Semont maneuver and Brandt-Daroff exercises on Benign Paroxysmal Positional Vertigo

Objective. This study aimed to examine the efficacy of single session of Semont maneuver and Brand Daroff exercises in treatment of BPPV. Methods. This controlled single blinded randomized control trial (RCT) approved by “IEC, GJUS&amp;T, Hisar” on vide letter no. PTY/2022/155 dated on 21/04/2022. 30 patients (18 years of age and above) of posterior semicircular canal BPPV divided into two groups; Group 1 (N=16) was intervention group treated with Semont maneuver &amp; Brandt-Daroff exercises and Group 2 (N=14) was control group in which Brandt-Daroff exercises were given. Subjects were diagnosed with the help of Dix-Hallpike maneuver, visual vertigo analysis scale, questionnaire for self-diagnosis of BPPV and dizziness handicap inventory score. Paired t-test was used to compare data within groups and unpaired t-test was used to compare data between intervention and control group. Results. VAS and total DHI scores at the start of the study were not statistically significant (p=0.28, p=0.80, respectively) between the treatment group and control group. VAS and DHI scores statistically significantly improved after the intervention in group 1 (VAS 6.75±.68, p&lt;0.001; Total-DHI =42.87±8.69; p&lt;0.001). On the other hand, in the group 2, no significant difference was observed (VAS 1.21±.68, p=0.56; Total-DHI =2.29±8.69; p=.67). In addition, significant improvements were observed in VAS and total DHI scores in patients who underwent the Semont maneuver and Brandt-Daroff compared to those in the group 2 (p&lt;0.01, p&lt;0.01, respectively). Conclusion. Semont maneuver and Brandt Daroff exercises are safe and more effective in treatment of BPPV in majority of patient.

Association of Cervical Spondylosis with Recurrence of Benign Paroxysmal Positional Vertigo: a case report

Benign Paroxysmal Positional Vertigo is thought to be the main cause of vertigo globally. It is recurrent and remediable disease accounts under peripheral vestibular disorder which involve one or more then on semicircular canal with floating and displaced otoconia. Activated afferents of semicircular canals produce false sensation of nystagmus. It is characterized by scanty spinning sensations initiated by head movements, commonly in the vertical or horizontal planes. BPPV is common in elderly population and is often undiagnosed or misdiagnosed. BPPV is mostly diagnosed by history and complete examination which involve the Dix-Hallpike maneuver consider as gold standard maneuver in assessment. BPPV is mostly treated conservatively utilizing various physiotherapeutic techniques. Patient education, Semont maneuver (SM), Epley maneuver, Brandt Daroff along with vestibular rehabilitation exercises are proven to be effective in improving sensations of vertigo and chances of reoccurrence. Keywords: Benign Paroxysmal Positional Vertigo, Cervical Spondylosis, Association

Gans repositioning maneuver for the posterior canal BPPV patients: systematic review and meta-analysis.

BPPV (benign paroxysmal positional vertigo) is a syndrome marked by brief bouts of vertigo accompanied by rapid changes in head position. Recent ongoing therapeutic approaches used are vestibular rehabilitation exercises and physical maneuvers like the Epley maneuver, Semont maneuver. Gans repositioning maneuver (GRM) is a new hybrid maneuver, consisting of safe and comfortable series of postures that can be conveniently applied on patients with any spinal pathology or even in elderly. Randomized controlled/clinical trials of the Gans maneuver were identified. The proportion of patients who improved as a result of each intervention was assessed, as well as the conversion of a 'positive' Dix-Hallpike test to a 'negative' Dix-Hallpike test. Improvement was seen in almost all patients with the Gans maneuver and the Epley Maneuver in three trials with the pooled estimate for random effect model is 1.12 [0.87; 1.43: 100%]. There were no significant side effects from the treatment. This study shows that the Gans maneuver is a safe and effective treatment for patients suffering from posterior canal BPPV. The review is registered in Prospero with no. CRD42021234100.

Failure of Gan CRM Overcome by Successful Semont Manoeuvre in BPPV Post Head Trauma: A Case Study

Objective: Benign paroxysmal positional vertigo (BPPV) is one of common peripheral vestibular problem reported that head injury is one of common cause among young age. In current situation it only treated by medication or injection by medical officer and specialist. Medication is not an optimal treatment and it only symptomatic therapy and often need chronic prescriptions if not treated properly. There are an optimum specific manoeuvre offers curative therapy in majority of BPPV cases such as Epley’s manoeuvre, Gan Canal repositioning Manoeuvrer (CRM) and Semont manoeuvre. Semont manoeuvre is one of selected manoeuvre that recently done in posterior BBPV case if Epley’s and Gan CRM failed, but less practice among our clinician due to less exposure.&#x0D; Case Studies: A 22 -year-old gentleman, complain of imbalance, difficulty in walking and vertigo for the past few days. He history of moderate traumatic brain injury (left parietooccipital Epidural Haemorrhage) and surgical intervention done last 5 days ago. He also complained of reduced hearing and on off left tinnitus over left side. No prominent psychological involvement reported.&#x0D; Detail physical and balance assessment done using BAL EX Foam test Modified Dix Hallpike Test (DHT) done. During the left DHT there is rotatory up beating nystagmus then it proceeds with GRM three-time, 1 session on previous day and 2 session on the current day but it was failed. Then proceed with Semont manoeuvre by specialist in vestibular rehabilitation. After 10 minutes of manoeuvre, modified DHT done and show negative result found there is no nystagmus.

Epley versus Semont Maneuver in the Treatment of Benign Paroxysmal Positional Vertigo

AbstractIntroduction Benign paroxysmal positional vertigo (BPPV) is characterized by brief but violent attacks of paroxysmal vertigo provoked by certain positions of the head. This study aimed to compare the outcomes of Epley and Semont maneuvers for the relief of vertigo in posterior semicircular canal BPPV.Materials and Methods This was a prospective comparative study conducted in a tertiary referral hospital over 1 year. Among 70 cases of BPPV, 35 were treated with Epley and 35 with Semont maneuver. Follow-up was done at 1 week, 1 month, and 3 months to assess symptomatic improvement using visual analogue scale.Results Out of 70 patients of BPPV, 62 patients responded very well to the maneuvers and got relief from vertigo. Thirty-two patients (91.4%) in the Epley group and 30 (85.7%) patients in the Semont group had a significant improvement post-therapy and the balance was the same in both groups. At 1 month, there was no significant statistical difference in mean visual analogue score (VAS) score between both groups.Conclusion Majority of cases showed symptomatic improvement with both maneuvers. However, patients treated with Epley maneuver showed earlier relief from vertigo than those treated with the Semont maneuver.

Current Therapies in Patients With Posterior Semicircular Canal BPPV, a Systematic Review and Network Meta-analysis.

To compare the efficacy of different treatments for posterior semicircular canal benign paroxysmal positional vertigo (PC-BPPV) by using direct and indirect evidence from existing randomized data. Randomized case-control studies that compared the efficacy of various nonsurgical treatments in PC-BPPV patients at 1 week and 1 month of follow-up were comprehensively screened. Bayesian network meta-analysis was performed to evaluate direct and indirect treatment comparisons. We further conducted subgroup pairwise meta-analysis to explore the inconsistency between comparisons of the Epley versus a sham maneuver and the Epley versus the Semont maneuver. A total of 41 parallel, randomized controlled studies were included. The Epley with vestibular rehabilitation (EVR), Epley, Semont and Hybrid maneuvers were effective in eliminating nystagmus during a Dix-Hallpike test at 1 week of follow-up (odds ratios [ORs]: 11.41-23.8, 95% credible interval [CrI]: excluding null), among which EVR showed the best efficacy (the surface area under the cumulative ranking curves [SUCRA] = 77.5%). However, at 1 month of follow-up, only the Semont (rank first, SUCRA = 76.1%) and Epley maneuvers (rank second, SUCRA = 65.3%) were effective in eliminating nystagmus during a Dix-Hallpike test. In the pairwise subgroup meta-analysis, for patients younger than 55 years of age, the efficacy of the Epley maneuver was comparable to that of the Semont maneuver [rate ratio (RR): 0.99, 95% confidence interval (CI): 0.93-1.05]; for patients with a longer duration before treatment, the effect of the Epley maneuver was equivalent to that of a sham maneuver (RR: 1.07, 95% CI: 0.90-1.29). Among the 12 types of PC-BPPV treatments, the Epley, Semont, EVR, and Hybrid maneuvers were effective in eliminating nystagmus during a Dix-Hallpike test for PC-BPPV at 1 week of follow-up, whereas only the Epley and Semont maneuvers were effective at 1 month of follow-up. The duration before treatments and the age of patients might contribute to the efficacy of treatments.

COMPARISON OF EFFICACY OF SEMONTS MANOEUVRE VERSUS VESTIBULAR SEDDATIVE IN POSITIONAL VERTIGO

Objective: To carry out the comparison of the effectiveness of Semont manoeuvre and Vestibular Sedative in the management of benign paroxysmal positional vertigo (BPPV).&#x0D; Study Design: Quasi experimental study.&#x0D; Place and Duration of Study: Department of ENT, Combined Military Hospital Peshawar Pakistan, from Jan to Jul 2020.&#x0D; Methodology: The study was conducted on 60 patients who were diagnosed Benign Paroxysmal Positional Vertigo by Dix Hallpike test. The patients were divided into 2 groups of 30 each. Group A was treated with vestibular sedative and group B was treated with Semont manoeuvre. The examination of all patients was done on day 3, day 7 and day 14 and the results were documented.&#x0D; Results: The study was conducted on 60 patients who were diagnosed benign paroxysmal positional vertigo by Dix Hallpike test the study revealed that the 30 cases which were treated by Semont manoeuvre, 25 cases were completely symptom free after 14 days. Meanwhile out of 30 cases which were managed by oral vestibular sedative, only 4 cases showed complete recovery after 14 days. Chi square test was used to compare the results. The results revealed that Semont manoeuvre is more effective in the treatment of benign paroxysmal positional vertigo than vestibular sedative.&#x0D; Conclusion: Semont manoeuvre is more effective in the management of benign paroxysmal positional vertigo than vestibular sedative.

The efficacy of Epley and Semont maneuvers in posterior semicircular canal benign paroxysmal positional vertigo treatment: A short-term comparative study

OBJECTIVE: This study aimed to compare the effectiveness of the Epley maneuver with the Semont maneuver in the treatment of posterior semicircular canal benign paroxysmal positional vertigo and observe differences in the resolution time of symptoms in the short-term follow-up. METHODS: Sixty patients with posterior semicircular canal benign paroxysmal positional vertigo (23 males, 37 females; median age: 44.9 years; range, 14 to 80 years) were included in the prospective randomized comparative study conducted in our clinic between April 2019 and October 2019. Diagnosis and treatment maneuvers were performed under videonystagmography examination. Participants were randomly selected after the diagnostic tests for the Epley maneuver and the Semont maneuver treatment groups. RESULTS: In the evaluation of vertigo with videonystagmography, 25 (83.3%) patients in the Epley maneuver group and 20 (66.6%) patients in the Semont maneuver group recovered in the one-week follow-up, and 28 (93.3%) patients in the Epley maneuver group and 24 (80%) patients in the Semont maneuver group recovered in the two-week follow-up. All patients in the Epley maneuver group recovered at the end of one month; four patients in the Semont maneuver group still had vertiginous symptoms (100% vs. 86.6%, p=0.04). There was a statistically significant difference between the Epley and Semont groups regarding visual analog scores at the one-week, two-week, and one-month follow-ups (p=0.002, p&lt;0.001, p=0.001, respectively). CONCLUSION: The Epley maneuver was significantly more effective than the Semont maneuver in resolving vertigo in the short-term treatment of posterior semicircular canal benign paroxysmal positional vertigo.

Comparison of outcomes of the Epley and Semont maneuvers in posterior canal BPPV: A randomized controlled trial.

ObjectivesThis study aims to compare the efficacy of the Epley and Semont maneuvers in relieving posterior canal benign paroxysmal positional vertigo (BPPV) arising in the in patients at the Outpatient Department of the Department of Otolaryngology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.MethodIn this prospective, randomized, comparative study, patients were assigned to receive one of the two treatment methods. First, BPPV was diagnosed with the Dix‐Hallpike test. Then, each patient was treated by either the Epley or Semont maneuver. Immediately afterward, the efficacy of treatments was evaluated with the Dix‐Hallpike test, and dizziness intensity was assessed with the visual analog scale (VAS).ResultsThis study enrolled 80 patients with posterior canal BPPV, 40 of which underwent the Epley maneuver and the other 40 underwent the Semont maneuver. In the first week, The Epley maneuver cured 37 (92.5%) of the 40 patients, and the Semont maneuver cured 36 (90%) of the 40 patients. Statistical analysis revealed no significant difference in the efficacy of these treatments (P = .251). Regarding dizziness intensity, VAS scores decreased from 6.48 to 1.65 after the Epley maneuver and from 6.53 to 2.18 after the Semont maneuver. Statistical analysis revealed that the Epley maneuver was superior to the Semont maneuver (P = .009) in reducing dizziness intensity.ConclusionsThe Epley and Semont maneuvers had similar efficacy in curing posterior canal BPPV. Regarding the severity of dizziness after treatment, the Epley maneuver produced significantly better results than did the Semont maneuver.Level of Evidence: II

Utricular Dysfunction by Subjective Visual Vertical after Canalolith Repositioning Maneuvers for Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo

Introduction: Residual vestibular dysfunction is a common sequela of benign paroxysmal positional vertigo (BPPV), causing morbidity even after the resolution of vertigo with otolith repositioning maneuvers. The subjective visual vertical (SVV) measurement is used to detect the vertical spatial disorientation which may be associated with utricular dysfunction. We used the bucket test to measure possible residual utricular dysfunction in patients with BPPV after successful treatment of BPPV with canalolith repositioning maneuvers. Objective: (1) To document the presence of utricular dysfunction after canalolith repositioning maneuvers for posterior semicircular canal BPPV using bucket test for SVV. (2) To compare the difference in residual utricular dysfunction represented by SVV after Epley's and Semont's maneuvers. Study Design: Prospective, clinical, single center, cross sectional study. Methods: Sixteen consecutive patients attending ENT OPD at a tertiary care hospital for canalolith repositioning maneuvers for posterior semi circular canal BPPV underwent bucket test for SVV on the first follow up after a single physician directed maneuver for the correction of BPPV. Results: Sixteen bucket test results were analyzed after repositioning manoeuvres – twelve of which were Epley's maneuver and four were Semont's maneuver. Fourteen had a deviation of SVV more than 2° s. There was a significantly lower mean deviation of SVV following Semont's maneuver versus Epley's maneuver. Conclusion: There is a residual vertical spatial disorientation following repositioning maneuvers which contributes to dizziness after treatment. Our new finding was a lower mean deviation in SVV after Semont's compared to Epley's maneuver. Larger studies are required to confirm our findings with better statistical weight.