Epley’s maneuver versus Semont’s maneuver in treatment of posterior canal benign positional paroxysmal vertigo

Ajayan P. V.; Aleena P. F.; Anju Mariam Jacob

doi:10.18203/2320-6012.ijrms20172574

Authors

Ajayan P. V. Department of ENT, Government Medical College, Thrissur, Kerala, India
Aleena P. F. Department of ENT, Government Medical College, Thrissur, Kerala, India
Anju Mariam Jacob Department of Anaesthesiology, Government Medical College, Thrissur, Kerala, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20172574

Keywords:

BPPV, Canalolithiasis, Cupulolithiasis, Dix Hallpike test, Otolith, Semicircular canal

Abstract

Background: Benign paroxysmal positional vertigo (BPPV) is characterized by brief but violent attacks of paroxysmal vertigo provoked by certain positions of the head. BPPV is the most common cause of vertigo, resulting from migration of otoconia into the semicircular canals. Majority of patients have posterior canal BPPV. Epley’s Canalith Repositioning and Semont Liberatory Maneuver have been shown to be highly efficacious in the successful

treatment of posterior canal BPPV. The main objective of this study was to compare the efficacy of Epley’s maneuver versus Semont’s maneuver in the management of benign paroxysmal positional vertigo.

Methods: This study was conducted in the Department of Otorhinolaryngology of a rural Medical College in Kerala, for a period of one and half year, from January 2015 to June 2016. It was an observational prospective cohort study. 200 patients with posterior canal BPPV were enrolled in this study based on inclusion and exclusion criteria. Patients were allotted alternatively to Epley’s group and Semont’s group, 100 patients in each group based on the treatment maneuvers they underwent. Efficacy of maneuvers were assessed at the end of 1st week, 1^st month and 3^rd month on the basis of resolution of symptoms and Dix-Hallpike negativity.

Results: Of the 100 cases managed by Epley’s maneuver 95 cases showed complete relief of symptoms after 3 months. Out of 100 cases managed by Semont’s maneuver, 94 cases showed complete recovery after 3 months. The results were compared by Chi square test, as the data was mainly qualitative in nature. The results of both the groups were compared at the end of 1^st week, 1^st month and 3^rd month, which revealed that both the Semont’s and Epley’s maneuver are equally effective in the treatment of posterior canal BPPV.

Conclusions: Both Epley’s and Semont’s maneuver are equally effective for treating the patients of posterior canal benign paroxysmal positional vertigo.

Metrics

Metrics Loading ...

Author Biography

Ajayan P. V., Department of ENT, Government Medical College, Thrissur, Kerala, India

Additional Professor,ENT

References

Newman-Toker DE, Hsieh YH, Camargo CA, Pelletier AJ, Butchy GT, Edlow JA. Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample. In: Mayo Clinic Proceedings. Elsevier. 2008;83(7):765-775.

Post RE, Dickerson LM. Dizziness: a diagnostic approach. Am Fam Physician. 2010;82(4):361-8.

Von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T, et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatr. 2007;78(7):710-5.

Oghalai JS, Manolidis S, Barth JL, Stewart MG, Jenkins HA. Unrecognized benign paroxysmal positional vertigo in elderly patients. Otolaryngol Head Neck Surg. 2000;122(5):630-4.

Fife D, Fitzgerald JE. Do patients with benign paroxysmal positional vertigo receive prompt treatment? analysis of waiting times and human and financial costs associated with current practice. Int J Audiol. 2005;44(1):50-7.

Baloh RW, Jacobson K, Honrubia V. Horizontal semicircular canal variant of benign positional vertigo. Neurology. 1993;43(12):2542.

Bertholon P, Bronstein AM, Davies RA, Rudge P, Thilo KV. Positional down beating nystagmus in 50 patients: cerebellar disorders and possible anterior semicircular canalithiasis. J Neurol Neurosurg Psychiatr. 2002;72(3):366-72.

Dix MR, Hallpike CS. The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system.

Semont A, Freyss G, Vitte E. Curing the BPPV with a liberatory maneuver. In: Clinical Testing of the Vestibular System. Karger Publishers. 1988:290-293.

Epley JM. The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 1992;107(3):399-404.

Brandt T, Bronstein AM. Cervical vertigo. J Neurol Neurosurg Psychiatr. 2001;71(1):8-12.

Mandalà M, Santoro GP, Libonati GA, Casani AP, Faralli M, Giannoni B, et al. Double-blind randomized trial on short-term efficacy of the Semont maneuver for the treatment of posterior canal benign paroxysmal positional vertigo. J Neurol. 2012;259(5):882-5.

Salvinelli F, Firrisi L, Casale M, Trivelli M, D'ascanio L, Lamanna F, et al. Benign paroxysmal positional vertigo: diagnosis and treatment. La Clinica Terapeutica. 2004;155(9):395-400.

Neuhauser H, Lempert T. Vertigo and dizziness related to migraine: a diagnostic challenge. Cephalalgia. 2004;24(2):83-91.

Caldas MA, Ganança CF, Ganança FF, Ganança MM, Caovilla HH. Clinical features of benign paroxysmal positional vertigo. Brazilian J Otorhinolaryngol. 2009;75(4):502-6.

Gans RE, Harrington-Gans PA. Treatment efficacy of benign paroxysmal positional vertigo (BPPV) with canalith repositioning maneuver and Semont liberatory maneuver in 376 patients. Seminars in Hearing. 2002:23(2):129-42.

Pośpiech L. Rehabilitation of benign paroxysmal positional vertigo in the experience of the Wroclaw Clinics. Otolaryngologia Polska The Polish otolaryngology. 1999;54(5):557-60.

Naimatullah YN. Single treatment approaches to benign paroxysmal positional vertigo. Pak J Otolaryngol. 2004;20:3-5.

Prokopakis EP, Chimona T, Tsagournisakis M, Christodoulou P, Hirsch BE, Lachanas VA, et al. Benign paroxysmal positional vertigo: 10‐year experience in treating 592 patients with canalith repositioning procedure. Laryngoscope. 2005;115(9):1667-71.

Wietske R, Bruintjes TD, Oostenbrink P, van Leeuwen RB. Efficacy of the Epley maneuver for posterior canal BPPV: a long-term, controlled study of 81 patients. Ear Nose Throat J. 2005;84(1):22.

Ruckenstein MJ. Therapeutic efficacy of the Epley canalith repositioning maneuver. Laryngoscope. 2001;111(6):940-5.

Lynn S, Pool A, Rose D, Brey R, Suman V. Randomized trial of the canalith repositioning procedure. Otolaryngol Head Neck Surg. 1995;113(6):712-20.

Ahmed Z, Akhtar MR, Ahmed T, Raza N, Ayub W. Modified Epley’s manoeuvre for treatment of benign positional vertigo: An experience with over 100 cases. Pak Armed Forces Med J. 2003;53:160-3.

Mazoor T, Niazi SB. Efficacy of Semont manoeuvre versus Epley manoeuvre in benign paroxysmal positional vertigo. Pak Armed Forces Med J. 2011:30(2).

Vaz GF. Treatment failures in benign paroxysmal positional vertigo. Role of vestibular rehabilitation. Revue de Laryngologie-Otologie-Rhinologie. 2004;126(4):271-4.

Dispenza F, Kulamarva G, De Stefano A. Comparison of repositioning maneuvers for benign paroxysmal positional vertigo of posterior semicircular canal: advantages of hybrid maneuver. Am J Otolaryngol. 2012;33(5):528-32.