Semont Maneuver Research Articles

Comparative efficacy of epley and semont maneuver in benign paroxysmal positional vertigo: A prospective randomized double-blind study

Objective: We compared the efficacy of Semont's maneuver with Epley's maneuver in the management of benign paroxysmal positional vertigo (BPPV).We conducted a randomized and prospective double-blind study. Materials and Methods: We included 60 diagnosed cases of BPPV. These patients were categorized into Group 1 and Group 2. Epley's maneuver was performed in 30 patients of Group 1. Semont's maneuver was performed in the rest of the 30 patients of Group 2. We included diagnosed patients of BPPV above 20 years of age of both genders. Patients having peripheral and central causes of vertigo and cervical spondylosis were excluded from the study. Results: The mean age in Group 1 and Group 2 were 50.07 and 44.87 years, respectively. Sixty five percent of the patients were females and 35% of the patients were males. A total of 26 out of 30 Group 1 (87%) patients and 17 out of 30 Group 2 (57%) patients showed improvement. Comparing the two groups on the basis of improvement after maneuver showed that Group 1had greater improvement (54%) compared to Group 2 (46%). Statistical tests such as Chi-square test and t-test were applied. Conclusions: Epley's maneuver is more effective in the treatment of BPPV than Semont's maneuver.

Treatment for Posterior Canal Benign Paroxysmal Positional Vertigo-A Critical Review

Benign paroxysmal positional vertigo (BPPV) defined by Dix and Hallpike is one of the most common disorders causing vertigo and fortunately, is a very simple disorder to manage. BPPV is more prevalent in adults and in women. Canalithiasis describes free-floating particles within a SCC. Cupulolithiasis describes particles attached to the cupula. BPPV can be caused either by canalithiasis or by cupulolithiasis, and can affect any of the three SCCs. BPPV mostly develops in the posterior semicircular canal. The main symptom of BPPV is vertigo induced by a change in head position with respect to gravity. The Dix-Hallpike test is the most commonly used test to confirm the diagnosis of posterior canal BPPV. Treatment options for posterior canal BPPV are Epley's maneuver, Liberatory maneuver and Brandt-Daroff exercises. Objective of this review is to find out which intervention is most effective in relieving symptoms. There are evidences that suggest performance of any of the three maneuvers can be expected to give good results in the management of posterior canal BPPV than placebo. The Epley's maneuver is a safe, effective treatment for posterior canal BPPV with confirmed evidence level A. Epley's maneuver is also comparable to the Semont maneuver which is difficult to perform for elderly for posterior canal BPPV. Both (Epley's maneuver and Semont maneuver) are more effective than Brandt-Daroff exercises in the short term but evidence suggests that Brandt-Daroff exercises should be incorporated in the long term as a preventative measure or to promote functional recovery.

Benign Paroxysmal Positional Vertigo: comparison of two recent international guidelines

Benign Paroxysmal Positional Vertigo (BPPV) is characterized by vertigo, lasting for a few seconds and usually managed by head positioning maneuvers. To educate clinicians concerning the state-of-the art knowledge about its management, the international societies developed guidelines. Aimthe aim of this paper is to discuss, in a practical fashion, the current options available to manage BPPV. MethodStudy design: non-systematic review. This study reviews two recent guidelines regarding the evaluation and treatment of BPPV. The first one was published by the American Academy of Otolaryngology Head and Neck surgery (AAO-HNS) and the other by the American Academy of Neurology (AAN). The similarities were presented in different tables. ResultsThose guidelines presented differences regarding methods. Only the AAO-HNS guidelines recommend the Dix-Hallpike test for the diagnosis of BPPV. Only canalith repositioning maneuver, Semont maneuver and vestibular rehabilitation had showed some benefit and were recommended as good treatment options. ConclusionsBoth guidelines fulfilled all the aspects required for clinicians to diagnosed and manage BPPV; only the AAO-HNS's guidelines were more comprehensive and of better quality.

Epley and Semont maneuvers for posterior canal benign paroxysmal positional vertigo: A network meta-analysis.

Using network meta-analysis, we aimed to compare the efficacy and safety of Epley and Semont maneuvers as treatment options for posterior canal benign paroxysmal positional vertigo. Network meta-analysis. Randomized controlled studies with a Jadad score ≥ 3 that used an Epley or Semont maneuver in posterior canal benign paroxysmal positional vertigo patients were analyzed in this project. The following efficacy outcomes included 1-week recovery rate and end of study recovery rate. Recurrence rate was used to assess the safety of each treatment. Of 589 articles, 12 studies that enrolled 999 posterior canal benign paroxysmal positional vertigo patients were selected. The pooled analysis revealed that the Epley maneuver was as efficacious as the Semont maneuver, in both the 1-week recovery rate and end of study recovery rate (odds ratio [OR] = 1.8, 95% confidence interval [CI] = 0.48-7.00; OR = 1.8, 95% CI = 0.47-7.20), and had a similar recurrence rate (OR = 1.00, 95% CI = 0.33-4.4). These two techniques were both better than sham-controlled treatment in the two efficacy indicators. No difference was observed in recurrence rate for treatments. The Epley maneuver was similar to the Semont maneuver in both efficacy and safety for posterior canal benign paroxysmal positional vertigo in short-term effects, and both were superior to the sham-controlled treatment. NA.

A Multicenter Randomized Double-Blind Study: Comparison of the Epley, Semont, and Sham Maneuvers for the Treatment of Posterior Canal Benign Paroxysmal Positional Vertigo

We evaluated the short-term efficacy of Epley, Semont, and sham maneuvers for resolving posterior canal benign paroxysmal positional vertigo (BPPV) in a prospective multicenter randomized double-blind controlled study. Subjects were randomly divided into three groups: Epley (36 patients), Semont (32 patients), and sham (Epley maneuver for the unaffected side, 31 patients). Out of 14 institutes which participated in this study, 5 institutes had previous experience of the Epley but not the Semont maneuver and the other 9 had previous experience of both maneuvers. Each maneuver was repeated twice if there was still positional vertigo or nystagmus on day 0, and the presence of nystagmus and vertigo on positional testing were evaluated immediately, 1 day, and 1 week after treatment. After the first maneuver, the Epley group showed a significantly higher resolution rate of positional nystagmus than the Semont or sham groups (63.9, 37.5, and 38.7%, respectively). After the second maneuver, the resolution rate (83.3%) of the Epley group was significantly higher than that (51.6%) of the sham group. At 1 day and 1 week after treatment, the resolution rate of the Epley group was significantly higher than those of the other groups. Similar results were seen for the resolution of positional vertigo. The Epley maneuver showed persistent resolution rates of positional vertigo and nystagmus without a fatigue phenomenon. The Epley maneuver was significantly more effective per maneuver than Semont or sham maneuvers for the short-term treatment of posterior canal BPPV. The Semont maneuver showed a higher success rate than the sham maneuver, but it was not significantly different.

Repositioning maneuvers for benign paroxysmal positional vertigo.

There are few conditions in neurology that are diagnosed with such ease and certainty as benign paroxysmal positional vertigo (BPPV). Repositioning maneuvers are highly effective in treating BPPV, inexpensive, and easy to apply. Surgery has a very minor role in the management of BPPV, and although medications may transiently ameliorate symptoms, they do not treat the underlying process. There is good evidence to support treatment of posterior canal BPPV with Epley or Semont maneuvers and horizontal canal BPPV with Gufoni maneuvers or BBQ roll (also known as Lempert 360 roll or log roll); and weaker evidence for head hanging maneuvers in the least common anterior canal variant. Since the therapeutic efficacy amongst maneuvers for each canal is comparable, the choice of treatment is generally based on clinician preference, complexity of the maneuvers themselves, poor treatment response to specific maneuvers, and musculoskeletal considerations such as arthritic changes and range of motion of the cervical spine. Treating posterior canal BPPV with Epley or Semont manuevers is comparable as far as efficacy and the ease with which maneuvers are performed. For horizontal canal BPPV, the Gufoni maneuver is easier to perform compared to the BBQ roll, as it requires that the clinician only identify the side of weaker nystagmus (regardless of whether it's geotropic or apogeotropic) and not necessarily the side involved. Anterior canal BPPV is rare and generally short-lived, but there is weak evidence that deep head hanging and a variety of eponymous maneuvers may hasten recovery. The advantage of deep head hanging maneuvers is that they can be effectively performed without knowledge of the side involved.

Canal conversion after repositioning procedures: comparison of Semont and Epley maneuver

Although the efficacy of Semont (SM) and Epley maneuvers (EM) for treatment of posterior canal benign paroxysmal positional vertigo (BPPV) is well established, data comparing SM and EM regarding maneuver-induced canal switch are lacking. We prospectively investigated 102 posterior canal BPPV patients after application of the Semont or the Epley maneuver and looked for the appearance of ipsilateral horizontal canal BPPV symptoms. Although treatment success was similar for SM and EM (67 and 76 %, respectively), there was a significant difference in posterior-to-horizontal canal switch rates. In particular, 4 of 51 patients (7.8 %) of the EM group converted to the geotropic type of horizontal canal BPPV, whereas none of the 51 SM patients exhibited a canal switch. All four patients were cleared with a single barbecue maneuver. Our data suggest a small but significant difference in canal switch rate between EM and SM, which could be partly explained by the higher number of maneuver steps during which the head is in the dependent position throughout the EM.

A Comparative Study on the effectiveness of Epleys Maneuver Over Semont Maneuver in Improving the Quality of Life in Subjects with Benign Paroxysmal Positional Vertigo

Objectives of The Study 1. To know the efficacy of Epley's maneuver in improving the QOL in subjects with PC-BPPV using DHI and VADL. 2. To know the efficacy of Semont maneuver in improving the QOL in subjects with PC-BPPV using DHI and VADL. 3. To know the efficacy of Epley's maneuver over Semont maneuver. Methodology: 50 subjects with BPPV were randomly divided into two groups, group I received Epley's maneuver (n=25), and group II received Semont maneuver (n=25). Both maneuvers were given therapy with respective procedure for three repetitions per session, one session per day and were given for 5 days in a week for 3 weeks. The questionnaire of DHI and VADL were evaluated on day 1, day7and day21 in both the groups. Results: After 3 weeks of treatment period, the subjects in group I [Epley's maneuver] had shown statistically significant improvement with the outcome measures at 2.18 F-table value compared with subjects in group II [Semont maneuver]. Conclusion: Epley's maneuver was found to be much effective in improving the quality of life in subjects with PC_BPPV than Semont maneuver.

Changes in presynaptic inhibition during movement restriction of unilateral lower limb in a hemiparetic patient and healthy individuals

WCN 2013 No: 1168 Topic: 36 — Other topic Changes in presynaptic inhibition during movement restriction of unilateral lower limb in a hemiparetic patient and healthy individuals M. Morishita, H. Yamaguchi, K. Egawa, A. Hirohata, M. Kobayashi. Kibi International University, Takahashi, Japan; Watanabe Hospital, Shiseikai Medical Corporation, Niimi, Japan; Graduate School, Waseda University, Tokorozawa, Japan Background:We previously reported that movement restriction of the non-paretic lower limb improved gait patterns in hemiparetic patients. Objective: We assessed presynaptic inhibition (PI) to determine if movement restriction of the non-paretic lower limb is regulated by upper motor neuron mechanisms in hemiparetic patients compared with healthy individuals. Patients and methods: This study included one hemiparetic patient and 16 young healthy individuals. Participants walked with a knee brace on the non-paretic/non-dominant side. The subjects walked normally for about 10 min and then with the brace for another 10 min (gait training period). PI was measured before and after every 5 min in both conditions. PI was assessed in the soleus muscle on the paretic/ dominant side, and conditioning stimulation of the common peroneal nerve was used prior to soleus H-reflex measurement. Results: The single limb support time for the paretic/dominant side was longer after gait training in both the hemiparetic and healthy individuals. Two-way ANOVA revealed a significant interaction for time and restriction effects in healthy individuals. After gait training, PI was greater than during normal walking conditions in healthy individuals. In the hemiparetic patient, only slight PI was observed before gait training, but PI appeared to the same degree as in healthy individuals after gait training. Conclusion: Our results suggest that gait training with a knee brace may be effective not only for improvement of gait patterns, but also for regulation of upper motor neuron systems caused by increasing weight bearing ratio in paretic lower limbs. doi:10.1016/j.jns.2013.07.2152 Abstract — WCN 2013 No: 1165 Topic: 36 — Other topic Comparison of reposition rate between headshaking maneuver and vibration maneuver in ageotrophic horizontal BPPV H.S. Han, D.S. Shin. Neurology, St Carollo Hospital, Suncheon-si, Republic of Korea Background: Benign paroxysmal positional vertigo (BPPV) is one of the most commondisorders causingdizziness. Posterior Canal(PC)-BPPVhas been said to account for 60–90% of all BPPV cases, and Horizontal Canal(HC)-BPPV for 5–30% of the cases. However, HC-BPPV now appears to be more prevalent than was previously thought. The apogeotropic type is usually persistent, resistant to reposition maneuver, and its pathophysiology is cupulolithiasis in majority. We compare reposition rate between headshaking with modified Semont maneuver and vibration with modified Semont maneuver. Method: The subjectwere 64 patientswith ageotrophic type of HC-BPPV whowere diagnosed by the supine roll test using videonystagmography. We perform modified Semont maneuver after headshaking on 33 patients. We performed modified Semont maneuver after vibration on 31 patients. The patients with remaining vertigo after maneuver were retreated with the same method. After 1 week, We interviewed all patients using call whether vertigo has subsided. 4 patients had vertigo but they didn't come to the hospital because of private reason (3 in headshaking group and 1 in vibration group). We count the number of performance and compare with headshaking group and vibration group. Result: Fifty twice maneuvers were performed in headshaking group and fiftieth maneuvers were performed in vibration group (P N 0.05). The more vertigo is severe, the less maneuver was performed in both groups. Conclusion: There is no significant difference in recurrence rate between headshaking group and vibration group. doi:10.1016/j.jns.2013.07.2153 Abstract — WCN 2013 No: 1163 Topic: 36 — Other topic Symbiosis of neuro-interventionists: From parallel practice to interdisciplinary patient care WCN 2013 No: 1163 Topic: 36 — Other topic Symbiosis of neuro-interventionists: From parallel practice to interdisciplinary patient care T.W. Leung, M. Tang, A. Chan, G.K. Wong, S.C. Yu. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region Backgrounds: In centers with endovascular service established by radiologists, neurosurgeon, cardiologists and/or vascular surgeons, budding interventional neurologists may struggle to portray their role. Objective: In a university teaching hospital, we delivered neurointerventional treatment by a team-oriented approach consisting of radiologists, neurosurgeons and interventional neurologists. We aimed to evaluate this multidisciplinary patient care model through a quantitative framework construct survey. Methods: Responded on a voluntary basis, doctors, nurses, and radiographers defined the existing mode of collaboration over a continuum with parallel practice and non-hierarchical integration at both ends, and gave opinions on 4 major aspects: philosophy (believes in benefits of interprofessional collaboration and knowledge of each other's treatment approach), trust, process (knowledge exchange, physician centrality and conflicts associated with interprofessional collaboration) and outcomes (job satisfaction, personal growth, intention to leave in the following year, and research output). Abstracts / Journal of the Neurological Sciences 333 (2013) e579–e628 e618

Comparison of reposition rate between headshaking maneuver and vibration maneuver in ageotrophic horizontal BPPV

Background: Benign paroxysmal positional vertigo (BPPV) is one of the most common disorders causing dizziness. Posterior Canal(PC)-BPPV has been said to account for 60–/INS;90% of all BPPV cases, and Horizontal Canal(HC)-BPPV for 5–/INS;30% of the cases. However, HC-BPPV now appears to be more prevalent than was previously thought. The apogeotropic type is usually persistent, resistant to reposition maneuver, and its pathophysiology is cupulolithiasis in majority. We compare reposi/INS;tion rate between headshaking with modified Semont maneuver and vibrat/INS;ion with modified Semont maneuver.

The efficacy of repositioning maneuver for horizontal semicircular canal benign paroxysmal positional vertigo

Objective To investigate the efficacy of repositioning maneuver for horizontal semicircular canal benign paroxysmal positional vertigo (HC-BPPV).Methods Barbecue maneuver was applied in 70 patients with bilateral geotropic nystagmus; Gufoni maneuver,modified Semont maneuver,and forced prolonged position were used in 17 patients with bilateral apogeotropic nystagmus.The efficacies were observed.Results The one-time recovery rate of Barbecue maneuver was 88.6％.5 patients with apogeotropic nystagmus were cured by switching to geotropic type after Gufoni maneuver.Eight patients with apogeotropic nystagmus who never switched to geotropic type became symptom-free after being treated with modified Semont maneuver,one patient who did not response to previous maneuver were cured after use of forced prolonged position,and 3 patients with apogeotropic nystagmus did not response to the therapy.Conclusions Barbecue maneuver is effective in the treatment of HC-BPPV with bilateral geotmpic nystagmus; but it is difficult to treat bilateral apogeotropic nystagmus with this maneuver.The maneuver remains to be further studied. Key words: Vertigo; Horizontal semicircular canal; Repositioning maneuver

Positional Dizziness

This article reviews the most common conditions that are caused by changes in head or body positions. Practical clinical methods to help distinguish vestibular from nonvestibular and central from peripheral vestibular positional dizziness are discussed. This article also reviews the treatment methods of selected canal variants of benign paroxysmal positional vertigo (BPPV). Two recent evidence-based guidelines have established canalith repositioning maneuvers (Epley and Semont maneuvers) as safe and highly effective in the treatment of posterior canal BPPV. Recent studies suggest the Gufoni and the Lempert roll (barbecue) maneuvers are effective in treating lateral canal forms of BPPV. Most cases of positional vertigo are of peripheral vestibular origin and can be effectively treated by simple positioning maneuvers. This article reviews the variants of BPPV encountered in clinical practice, including mechanistic cause, differential diagnosis, prognosis, and treatment. Generous use of figures is intended to aid in understanding the most effective treatment maneuver techniques for the more common forms of BPPV. Clinicians who can recognize the types of nystagmus associated with the various canal types of BPPV can usually recognize CNS causes as distinct.

Short-Term Efficacy of Semont Maneuver for Benign Paroxysmal Positional Vertigo

To assess the short-term efficacy of Semont maneuver for unilateral posterior semicircular canal benign paroxysmal positional vertigo (PC-BPPV). The short-term efficacy of Semont maneuver was compared with a sham procedure in 128 patients with PC-BPPV by using a double-blinded prospective randomized controlled trial in the setting of a neurologic outpatient clinic in China. Analysis was based on the symptomatic status and the Dix-Hallpike maneuver on the fourth day. At this time, patients in both groups with a still positive Dix-Hallpike test were treated with Semont maneuver, and outcome was again assessed on the seventh day. On the fourth day, 55 (84.62%) of 65 patients in the treatment group showed complete resolution of symptoms compared with 9 (14.29%) of 63 patients in the control group. (p < 0.001) 59 (90.77%) of 65 and 52 (82.54%) of 63 patients reported resolution of symptoms in the treatment and original sham group, respectively (p = 0.17). Semont maneuver is shown to resolve PC-BPPV effectively, and patients should receive Semont maneuver once the PC-BPPV diagnosis was confirmed.

Benign paroxysmal positional vertigo of the posterior semicircular canal: efficacy of Santiago treatment protocol, long-term follow up and analysis of recurrence

To evaluate the efficacy of the Santiago treatment protocol for benign paroxysmal positional vertigo of the posterior semicircular canal, to analyse recurrence and to establish prognostic factors. Four hundred and twelve patients with unilateral benign paroxysmal positional vertigo of the posterior semicircular canal were treated with the Semont manoeuvre and, if symptoms did not resolve, successive application of three Epley manoeuvres plus Brandt-Daroff exercises. Symptoms resolved in 404 patients (98.1 per cent); a single Semont manoeuvre was sufficient in 334 (81.2 per cent). Aetiology had no impact on resolution of symptoms or number of manoeuvres required. The estimated likelihood of recurrence was 14 per cent in the first year and 27 per cent after 10 years. The only factor indicating a worse prognosis was recurrence. In unilateral benign paroxysmal positional vertigo of the posterior semicircular canal, the above treatment protocol cured 98 per cent of patients. More than half of recurrences occurred in the first year. None of the analysed factors increased the likelihood of recurrence.

Early Effect of Barbecue Rotation and Modified Semont Combination in Apogeotropic Horizontal Canal Benign Paroxysmal Positional Vertigo

Received April 16, 2012 Revised June 30, 2012 Accepted July 3, 2012 Address for correspondence Kyu Hwan Jung, MD Department of OtorhinolaryngologyHead and Neck Surgery, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 612-030, Korea Tel +82-51-797-0665 Fax +82-51-797-2304 E-mail kwmedi@gmail.com Background and ObjectivesZZBenign paroxysmal positional vertigo (BPPV) of horizontal canal shows reversible direction changing positional nystagmus and diverse clinical courses because of the frequent clinical presentation of cupulolithiasis. The aim of this study is to find out the early effect of particle repositioning maneuver (PRM) including the barbecue and the modified Semont in single treatment session for the apogeotropic horizontal canal BPPV. Subjects and MethodZZThirty-three episodic vertigo patients with direction-changing apogeotropic horizontal nystagmus were enrolled in this study. The patients were initially treated with barbecue rotation and the second PRM was applied 15 minutes after the first PRM. Barbecue rotation was applied when the positional nystagmus was changed its direction to that of geotropic. The modified Semont maneuver or barbecue rotation was randomly applied when nystagmus was not changed. Patients were followed-up 2 or 3 days after the initial visit and the nystagmus was rechecked to determine the single session treatment result. ResultsZZThe combination of PRMs in a single treatment session was effective in 23 out of 33 (69.7%) patients. An initial barbecue rotation was effective in 17 patients (51.5%); geotropic nystagmus was obtained in 12, and no nystagmus in 5. Eleven out of 16 (68.8%) patients with persistent apogeotropic nystagmus after initial treatment were successfully treated with the second PRM. There was no statistical difference between the second PRMs of the modified Semont maneuver and barbecue rotation (p=1.000). ConclusionZZThe combination of PRMs including barbecue rotation and the modified Semont maneuver in a single treatment session showed a comparable success rate as the previously reported studies. Korean J Otorhinolaryngol-Head Neck Surg 2012;55:429-34

Double-blind randomized trial on short-term efficacy of the Semont maneuver for the treatment of posterior canal benign paroxysmal positional vertigo

The need for Class I and II studies on the efficacy of Semont's liberatory maneuver (SLM) in the treatment of posterior canal benign paroxysmal positional vertigo (PC-BPPV) motivated the present double-blind randomized trial on the short-term efficacy of SLM. A total of 342 patients with unilateral PC-BPPV were recruited for a multicenter study. Patients were randomly assigned to treatment by SLM (n = 174) or sham treatment (n = 168). Subjects were followed up twice (1 and 24 h) with the Dix-Hallpike maneuver by blinded examiners. At the 1 and 24 h follow-up, 79.3 and 86.8%, respectively, of patients undergoing SLM had recovered from vertigo, compared to none of the patients undergoing the sham maneuver (p < 0.0001). Patients who manifested liberatory nystagmus at the end of SLM showed a significantly higher percentage of recovery (87.1 vs. 55.7%; p < 0.0001). To the best of our knowledge, this is the first Class I study on the efficacy of SLM. SLM proved highly effective with respect to the sham maneuver (p < 0.0001). Liberatory nystagmus was demonstrated to be a useful prognostic factor for the efficacy of treatment. The present Class I study of efficacy of SLM changes the level of recommendation of the maneuver for treating PC-BPPV from level C to level B.

Can We Predict the Efficacy of the Semont Maneuver in the Treatment of Benign Paroxysmal Positional Vertigo of the Posterior Semicircular Canal?

To establish success- or failure-predicting factors in Semont maneuver in the treatment of benign paroxysmal positional vertigo. Prospective study. Referral center, institutional practice, ambulatory care (outpatient clinic). A consecutive sample of 135 patients diagnosed with unilateral benign paroxysmal positional vertigo of posterior semicircular canal for 3 years (September 2007 to August 2010). Semont maneuver. Duration of the latency period and nystagmus status with the Dix-Hallpike test. Presence or absence of orthotropic nystagmus in the second position of the Semont maneuver. Effectiveness of the Semont maneuver (cure versus no cure). The Semont maneuver is effective in 73% of the patients. Orthotropic nystagmus was present in 67% of the cases and absent in 33%; when we found orthotropic nystagmus, the maneuver was effective in 81% of the patients, but only in 57% if this nystagmus was not present (Fisher's exact test, p = 0.004; odds ratio, 3.308; 95% confidence interval, 1.492-7.334). The maneuver's efficacy and the presence of orthotropic nystagmus were not affected by the duration of nystagmus status in the Dix-Hallpike test. The duration of the latency period had no effect on the maneuver's efficacy, but it did affect the appearance of orthotropic nystagmus (Mann-Whitney test, p = 0.016). The presence of orthotropic nystagmus in the second position of the Semont maneuver indicates a good prognosis, but its absence does not necessarily mean that the maneuver will fail. Orthotropic nystagmus is more common in patients with shorter latency periods, suggesting that its appearance is related to cupulolithiasis mechanisms.

Comparative Study between Epley and Semont Maneuvers to Treat Benign Paroxysmal Positional Vertigo

Objective: Compare the efficacy of Epley and Semont maneuvers to treat benign paroxysmal positional vertigo (BPPV). Method: Retrospective study conducted by analysis of medical records of 139 patients with a diagnostic hypothesis of ductolithiasis of posterior semicircular canal. Patients were treated by maneuvers repeated weekly until the abolition of nystagmus. Results: It took an average of 1.29 Epley maneuvers and 1.13 Semont maneuvers to eliminate the positional nystagmus ( P = .086). Conclusion: Semont maneuver tended to a lower average number of therapy sessions.

Are Postural Restrictions Necessary for Management of Posterior Canal Benign Paroxysmal Positional Vertigo?

An important component of management of benign paroxysmal positional vertigo (BPPV) has been the application of postural restrictions after use of a canalith repositioning maneuver (CRM) to prevent the return of otolithic debris into the posterior semicircular canal (PSC). This study was designed to explore the effectiveness of postural restrictions in patients with BPPV caused by otolithic debris in the PSC. Seventy-four adult patients with unilateral PSC BPPV were enrolled into this study. All patients were managed with a CRM--either the modified Epley maneuver or the Semont maneuver. The patients were divided randomly into 2 groups: group A, with postural restrictions, and group B, without postural restrictions. The statistical analysis was performed with X2 tests and t-tests. No patients in either group showed positional nystagmus in the posttreatment evaluation under infrared videonystagmoscopy. No patients had symptoms of vertigo after the therapy. The results of follow-up vestibular tests were normal in both groups. In our experience, postural restrictions do not enhance the beneficial effect of the CRMs. They do not seem to have any protective role and therefore should not be recommended as an adjunct to the treatment of PSC BPPV.

Semont's maneuver for treatment of benign paroxysmal positional vertigo

Along with Epley's canalith repositioning maneuver, the Semont maneuver is also recognized as an effective physical therapy for benign paroxysmal positional vertigo. However, the details of this maneuver are not well known, presumably because of the obscurity of the original description by Semont et al. In Japan, the “Semont liberatory maneuver,” as described by Brandt, is accepted as the “original” Semont maneuver. However, the two maneuvers are not identical. The aim of this paper was to reproduce the original procedure of Semont's as presented by A. Semont himself at the 10th Nagoya Otorhinolaryngological Forum held in Nagoya, Japan, in 2006. This lecture clarified some obscure points in the original paper; however, the procedure described at the forum was not a detailed reproduction of the original Semont maneuver, but was somewhat more complicated. Also of note, Semont decisively denied the cupulolithiasis theory and explained the usefulness of his maneuver according to the canalolithiasis theory.