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

Abstract

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.

Automated Mechanical Repositioning Treatment for Posterior Canal Benign Paroxysmal Positional Vertigo: A Single-Center Experience and Literature Review

“…EM is the most commonly used repositioning maneuver for the treatment of PC-BPPV, and its efficacy has been evaluated in many studies [4, 19, 20]. According to previous studies, success rates of EM vary greatly [19-21].…”

Diagnosis and treatment choices of suspected benign paroxysmal positional vertigo: current approach of general practitioners, neurologists, and ENT physicians

“…The gold standard for the diagnosis of the most frequent variant -posterior semicircular canal BPPV -is specific nystagmus induced by Dix-Hallpike positional maneuver [4][5][6][7]. 90% of BPPV cases are treatable with canalith repositioning procedures (CRPs), such as Epley maneuver for the posterior semicircular canal BPPV [5,8,9], which has a treatment success rate of 80-90% [5,[10][11][12][13][14][15].…”

Physical Therapy for Posterior and Horizontal Canal Benign Paroxysmal Positional Vertigo: Long-term Effect and Recurrence: A Systematic Review

“…In relation to the recurrence rate, it was lower in the group treated with the Epley maneuver, which had no patient with recurrent vertigo and nystagmus one week after treatment; while there were 3 cases of recurrence with the Semont maneuver. 11 For the horizontal canal, the intervention with the Gufoni and Barbecue maneuvers proved highly effective, with 92 and 93% treatment success rates, respectively. 12, 13 Testa et al, in their study, revealed that there is no difference between the Gufoni and the modified Gufoni maneuvers.…”

“…7 When comparing the Epley and Semont maneuvers in the resolution of patients' complaints, the results were similar, with no statistical significance (success rate in treating 48% of patients with only one Semont maneuver, and 40% with one Epley maneuverp < 0.01). 10 However, Lee et al 11 showed that 63.9% of the sample had an improvement in the symptoms with up to 2 maneuvers, a rate higher than those of the Semont and the sham groups, which, with the same amount of maneuvers, had 37.5% and 38.7% of patients with resolution of symptoms respectively. In relation to the recurrence rate, it was lower in the group treated with the Epley maneuver, which had no patient with recurrent vertigo and nystagmus one week after treatment; while there were 3 cases of recurrence with the Semont maneuver.…”