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European Archives of Oto-Rhino-Laryngology

23-04-2024 | Benign Paroxysmal Positional Vertigo | Otology

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

Authors: Bandana Thakur, Poonam Raj, Kamalpreet Singh, Viswanathan Anand

Published in: European Archives of Oto-Rhino-Laryngology

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Abstract

Introduction

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.

Materials and methods

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 2 weeks for clinical assessment with repeat Dix–Hallpike and VAS.

Results

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).

Conclusion

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.
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Literature
1.
Dix R, Hallpike CS (1952) The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system. Ann Otol Rhinol Laryngol 6:987–1016CrossRef
2.
von Brevern M (2013) Benign paroxysmal positional vertigo. Semin Neurol 33(03):204–211CrossRef
3.
Gupta AK, Sharma KG, Sharma P (2019) Effect of Epley’s, Semont’s Maneuvers and Brandt–Daroff exercise on quality of life in patients with posterior semicircular canal benign paroxysmal positional vertigo (PSCBPPV). Indian J Otolaryngol Head Neck Surg 71(1):99–103CrossRefPubMed
4.
Burton MJ, Eby TL, Rosenfeld RM (2012) Extracts from the Cochrane Library: modifications of the Epley (canalith repositioning) maneuver for posterior canal benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 147:407–411CrossRefPubMed
5.
Baloh RW, Honrubia V, Jacobson K (1987) Benign positional vertigo: clinical and oculographic features in 240 cases. Neurology 37(3):371CrossRefPubMed
6.
7.
8.
Hall SF, Ruby RR, McClure JA (1979) The mechanics of benign paroxysmal vertigo. J Otolaryngol 8(2):151–158PubMed
9.
Fife TD, Iverson DJ, Lempert T, Furman JM, Baloh RW, Tusa RJ, Hain TC, Herdman S, Morrow MJ, Gronseth GS (2008) Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence-based review): [RETIRED] Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 70(22):2067–2074CrossRefPubMed
10.
Herdman SJ, Tusa RJ, Zee DS, Proctor LR, Mattox DE (1993) Single treatment approaches to benign paroxysmal positional vertigo. Arch Otolaryngol Head Neck Surg 119(4):450–454CrossRefPubMed
11.
Ramakrishna J, Goebel JA, Parnes LS (2012) Efficacy and safety of bilateral posterior canal occlusion in patients with refractory benign paroxysmal positional vertigo: case report series. Otol Neurotol 33(4):640–642CrossRefPubMed
12.
Joshi D, Gyanpuri V, Pathak A, Chaurasia RN, Singh V, Dhiman NR (2021) Epley Maneuver versus Gans repositioning maneuver in treating posterior canal BPPV and familial incidence of BPPV: protocol for a randomized controlled trial. Indian J Otolaryngol Head Neck Surg 20:1–6
13.
Sen K, Sarkar A, Raghavan A (2016) Comparative efficacy of epley and semont maneuver in benign paroxysmal positional vertigo: a prospective randomized double-blind study. Astrocyte 3(2):96CrossRef
14.
Ajayan PV, Aleena PF, Jacob AM (2017) Epley’s maneuver versus Semont’s maneuver in treatment of posterior canal benign positional paroxysmal vertigo. Int J Res Med Sci 5:2854–2860CrossRef
15.
Salvinelli F, Casale M, Trivelli M et al (2003) Benign paroxysmal positional vertigo: a comparative prospective study on the efficacy of Semont’s maneuver and no treatment strategy. La ClinicaTerapeutica. 154(1):7–11
16.
Nadagoud SV, Bhat VS, Pragathi BS (2023) Comparative efficacy of Epley, Semont and Gans Maneuver in treating posterior canal benign paroxysmal positional vertigo. Indian J Otolaryngol Head Neck Surg 25:1–7
17.
Mishra P, Sindhu KL, Chethana R, Kaushik M (2023) Epleys versus semont’s manoeuvre in posterior canal benign paroxysmal positional vertigo. Indian J Otolaryngol Head Neck Surg 75(Suppl 1):523–527CrossRefPubMedPubMedCentral
18.
Celis-Aguilar E, Mayoral-Flores HO, Torrontegui-Zazueta LA, Medina-Cabrera CA, León-Leyva IC, Dehesa-López E (2022) Effectiveness of Brandt Daroff, Semont and Epley maneuvers in the treatment of Benign Paroxysmal Positional Vertigo: a randomized controlled clinical trial. Indian J Otolaryngol Head Neck Surg 1:1–8
19.
Kesimli MC, Kaya D, Ceylan S, Ceylan A, Ünal M. The efficacy of Epley and Semont maneuvers in posterior semicircular canal benign paroxysmal positional vertigo treatment: a short-term comparative study
20.
Strupp M, Mandala M, Vinck AS, Van Breda L, Salerni L, Gerb J, Bayer O, Mavrodiev V, Goldschagg N (2023) The Semont-Plus Maneuver or the Epley maneuver in posterior canal benign paroxysmal positional vertigo: a randomized clinical study. JAMA Neurol 80(8):798–804CrossRefPubMed
Metadata
Title
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
Authors
Bandana Thakur
Poonam Raj
Kamalpreet Singh
Viswanathan Anand
Publication date
23-04-2024
Publisher
Springer Berlin Heidelberg
Published in
European Archives of Oto-Rhino-Laryngology
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI
https://doi.org/10.1007/s00405-024-08657-2