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

Soto-Varela, Andrés; Rossi-Izquierdo, Marcos; Santos-Pérez, Sofía

doi:10.1097/mao.0b013e3182267f02

Cited by 21 publications

(30 citation statements)

References 16 publications

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“…Despite the well-known phenomenon of fatigue that can mimic successful treatment due to dispersion of particles in the canal after repeated positional maneuvers [7], we did not find any statistically significant differences between the 1 and the 24 h follow-ups. We confirmed the utility of the so-called 'liberatory nystagmus' [6,8] as a prognostic factor for efficacy of treatment in most cases; nevertheless, its absence does not necessarily mean that the maneuver will be unsuccessful [8]. More than one maneuver was needed to treat the PC-BPPV in 15% of subjects.…”

Section: Discussionsupporting

confidence: 75%

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

et al. 2011

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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.

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Section: Discussionsupporting

confidence: 75%

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

et al. 2011

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“…Authors such as Oh et al [5] and Soto-Varela et al [6] have reported the need to be attentive to the presence of a nystagmus with the same characteristics as that observed in the diagnostic tests: 'orthotropic nystagmus.' This finding could be associated with a better prognosis after repositioning maneuvers as it indicates that particles are moving in the ampullofugal direction during the corresponding CRM.…”

Section: Discussionmentioning

confidence: 94%

“…The presence of a nystagmus observed throughout the different positions of the maneuver, with the same fast phase direction as detected during the first position [5,6], i.e. ON, was registered and characterized.…”

Section: Methodsmentioning

confidence: 99%

“…When nystagmus had similar features, it would be called orthotropic nystagmus (ON). In the last few years different authors have described this so-called ON in the repositioning maneuvers and have associated it with a positive prognostic feature in the treatment of BPPV [5,6]. Attentiveness to its impact on quality of life and emotional impact after treatment were also the focus of this study.…”

Section: Introductionmentioning

confidence: 97%

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Repositioning nystagmus: prognostic usefulness?

Castillo

Santos

et al. 2014

Acta Oto-Laryngologica

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The posterior semicircular canal (SCC) was affected in 84.2% of cases, the horizontal SCC in 10.5%, and the anterior SCC in 5.1%. Appropriate CRMs were performed. ON was present in 67% of cases. Overall resolution after the first treatment was achieved in 56% of cases. With ON present the success rate was 63% and when not observed the rate was 42%. DHI or CIEV scores were not significantly different when comparing the presence vs absence of ON. In nine patients (16%) an abnormal CIEV score was observed after treatment, even though a cured status was achieved in six of these nine patients.

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“…Among the most widely accepted theories aiming to explain this phenomenon is the canalithiasis theory, which states that otoconial debris are freely floating in the endolymph of the semicircular canal [Parnes and McClure, 1992], and the cupulolithiasis theory, in which the particles are at least partly adhered to the cupula of the ampullar end of the canal [Schuknecht, 1969]. For the last few years, BPPV treatment has been based on particlerepositioning maneuvers or canalith repositioning procedures (CRPs) that aim at removing otoconial debris from the semicircular canal and returning them to the vestibule [Soto-Varela et al, 2011].…”

Section: Introductionmentioning

confidence: 99%

Canalith Repositioning Procedures among 965 Patients with Benign Paroxysmal Positional Vertigo

Prokopakis¹,

Vlastos²,

Tsagournisakis

et al. 2012

Audiol Neurotol

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Background: Canalith repositioning procedure (CRP) has increasingly been utilized for the last 15 years for the treatment of benign paroxysmal positional vertigo (BPPV). We assess the short- and long-term efficacy of CRP on the treatment of patients with BPPV. Methods: Nine hundred sixty-five patients (481 men and 484 women, from 18 to 87 years of age) were enrolled in this prospective study during 1995–2010. Inclusion criteria were a patient history compatible with BPPV and a positive provocative maneuver (either Dix-Hallpike or Roll test). Reported duration of symptoms at the time of their first examination varied from 1 day to 18 months. Variants of the Epley and Barbeque maneuver were used for posterior and anterior canal involvement, and horizontal canal involvement, respectively. Short-term follow-up was obtained 48 h and 7 days after initial treatment, whereas long-term follow-up was obtained at repeated 6-month intervals. Results: Symptoms subsided immediately in 819 patients (85%) by the first CRP. Only 19 patients (2%) required CRP more than 3 times. Patients’ mean follow-up was 74 months; symptom recurrence was noted in 139 patients. A statistically significantly higher recurrence rate was noted in elderly people or those with head trauma or a history of vestibular neuropathy (p < 0.001). Conclusions: This study provides class IV evidence that CRP remains an efficient and long-lasting noninvasive treatment for BPPV, especially for younger patients without a history of head trauma or vestibular neuropathy. Elderly people have a significantly higher recurrence rate requiring additional education to minimize potential morbidity of their falls.

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

Cited by 21 publications

References 16 publications

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

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

Repositioning nystagmus: prognostic usefulness?

Canalith Repositioning Procedures among 965 Patients with Benign Paroxysmal Positional Vertigo

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