Semont-plus maneuver bests EM self-maneuver in shortening recovery days in posterior canal BPPV

New research revealed that Semont-plus maneuver (SM-plus) is superior over Epley maneuver (EM) for treatment of posterior canal benign paroxysmal positional vertigo (pcBPPV) canalolithiasis. The study results were published in the journal JAMA Neurology.

Benign paroxysmal positional vertigo (BPPV) is characterized by recurrent brief episodes of spinning positional vertigo, provoked by lying down or turning over in the supine position. Posterior canal is affected in majority of the cases hence called the posterior canal BPPV (pcBPPV) canalolithiasis. Epley repositioning maneuver (EM) and the Semont maneuver (SM) are the therapies of choice for treating pcBPPV. These can be applied as self maneuvers. Recently using a biophysical model and computer simulations, SM-plus was developed where the patient is moved by at least 240° toward the nonaffected side yielding better results. Hence researchers conducted a prospective randomized clinical trial to compare the effectiveness of the Semont-plus maneuver (SM-plus) and the Epley maneuver (EM) for treatment of posterior canal benign paroxysmal positional vertigo (pcBPPV) canalolithiasis.

The trial was performed at 3 national referral centers (in Munich, Germany; Siena, Italy; and Bruges, Belgium) over 2 years, with a follow-up to 4 weeks after the initial examination. Recruitment took place from June 1, 2020, until March 10, 2022. Nearly 253 eligible patients were randomly selected during routine outpatient care after being referred to 1 of the 3 centers. Among them 56 patients were excluded and 2 declined to participate, with 195 participants included in the final analysis. As per the prespecified protocol, patients were randomized to SM-plus or the EM group where they received 1 initial maneuver from a physician, then subsequently performed self-maneuvers at home 3 times in the morning, 3 times at noon, and 3 times in the evening.