|ORIGINAL CONTRIBUTION - CLINICS IN OTORHINOLARYNGOLOGY
|Year : 2016 | Volume
| Issue : 2 | Page : 96-99
Comparative efficacy of epley and semont maneuver in benign paroxysmal positional vertigo: A prospective randomized double-blind study
Kanwar Sen1, Aniruddha Sarkar1, Anil Raghavan2
1 Department of Otolaryngology and Head and Neck Surgery, Dr. Ram Manohar Lohia Hospital, New Delhi, India
2 ENT, Dr. Ram Manohar Lohia Hospital, New Delhi, India
|Date of Web Publication||30-Dec-2016|
Senior Resident, Ms Ent, Dnb Ent, Dr. Ram Manohar Lohia Hospital, New Delhi
Source of Support: None, Conflict of Interest: None
Objective: We compared the efficacy of Semont's maneuver with Epley's maneuver in the management of benign paroxysmal positional vertigo (BPPV).We conducted a randomized and prospective double-blind study. Materials and Methods: We included 60 diagnosed cases of BPPV. These patients were categorized into Group 1 and Group 2. Epley's maneuver was performed in 30 patients of Group 1. Semont's maneuver was performed in the rest of the 30 patients of Group 2. We included diagnosed patients of BPPV above 20 years of age of both genders. Patients having peripheral and central causes of vertigo and cervical spondylosis were excluded from the study. Results: The mean age in Group 1 and Group 2 were 50.07 and 44.87 years, respectively. Sixty five percent of the patients were females and 35% of the patients were males. A total of 26 out of 30 Group 1 (87%) patients and 17 out of 30 Group 2 (57%) patients showed improvement. Comparing the two groups on the basis of improvement after maneuver showed that Group 1had greater improvement (54%) compared to Group 2 (46%). Statistical tests such as Chi-square test and t-test were applied. Conclusions: Epley's maneuver is more effective in the treatment of BPPV than Semont's maneuver.
Keywords: BPPV, Epley′s maneuver, Semont′s maneuver
|How to cite this article:|
Sen K, Sarkar A, Raghavan A. Comparative efficacy of epley and semont maneuver in benign paroxysmal positional vertigo: A prospective randomized double-blind study. Astrocyte 2016;3:96-9
|How to cite this URL:|
Sen K, Sarkar A, Raghavan A. Comparative efficacy of epley and semont maneuver in benign paroxysmal positional vertigo: A prospective randomized double-blind study. Astrocyte [serial online] 2016 [cited 2021 Jan 28];3:96-9. Available from: http://www.astrocyte.in/text.asp?2016/3/2/96/197214
| Introduction|| |
In the general population, vertigo and dizziness are fairly common symptoms.  Many of these patients suffer with benign paroxysmal positional vertigo (BPPV), which 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. 
The age of onset of BPPV is most commonly between the 5th and 7th decade of life. Also, approximately half of the patients with severe traumatic brain injury who complain about positional vertigo suffer from BPPV. 
Characteristically, it is the change in position of the head that provokes an episode of BPPV. The episode occurs when the patient rolls over onto the affected side or tilts the head back while looking in an upward direction. It may be accompanied by episodes of severe nausea and vomiting. The Dix-Hallpike test is positive when an anticlockwise rotatory nystagmus occurs toward the under most ear.
Treatment of BPPV is based on Semont's and Epley's maneuvers. Although a few cases may be self-limiting. 
Studies have shown that canal repositioning procedures remain an efficient and long lasting noninvasive treatment of BPPV.  However, some controversy still exists regarding whether these maneuvres actually have an effect other than central habituation. Moreover, resistant cases and variants of the disease remain a significant problem. 
Aims and Objectives
- To compare the efficacy of Semont's maneuver with Epley's maneuver in the management of BPPV
- To find which of these maneuvers is associated with the least recurrence of BPPV.
| Materials and Methods|| |
This was a randomized, prospective double-blinded study, conducted in a tertiary care centre over a period of 18 months from 1st November 2013 to 31st March 2015 and includes a total of 60 patients with BPPV. While Epley's maneuver was performed in 30 patients, in the other 30 Semont's maneuver was carried out.
- Diagnosed patients of BPPV above 20 years of age, both males and females
- Diagnostic criteria:
- Vertigo associated with a characteristic mixed torsional and vertical nystagmus provoked by the Dix-Hallpike test using FRENZEL's glasses to observe nystagmus
- An average latency of 20s between the completion of the Dix-Hallpike test and the onset of vertigo and nystagmus
- Fatigability (i.e., a reduction in vertigo and nystagmus if the Dix-Hallpike test is repeated).
- Patients having severe cervical spondylitis
- Patients with spinal injury
- Patients with central causes of vertigo
- Other causes of peripheral vertigo such as Meniere's disease, vestibular neuritis, labrynthitis, and perilymphatic fistula.
| Results|| |
Patients in whom Epley's maneuver was performed were designated as group 1 and those in whom Semont's maneuver was performed were designated as group 2. There were 30 patients of BPPV randomly selected in group 1 and 30 in group 2. The mean age in group 1 was 50.07 years, and in group 2 it was 44.87 years, as shown in [Table 1]. The difference in age group was not significant between the two groups.
In group 1, 20 (66.7%) were females and 10 (33.3%) were males. In group 2, 19 (63.3%) were females and 11 (36.7%) were males. Thus in this study 65% of the patients were females and 35% were males [Table 2].
Group 1 was treated with Epley's maneuver. Out of 30 patients, 26 patients (approximately 87%) showed improvement in symptoms and reduction in frequency of attacks of paroxysmal positional vertigo and 4 patients (approximately 13%) showed no improvement in 1st week of the treatment. The 26 patients who improved in the 1st week showed improvement during follow-up at 4 weeks and 6 weeks, with no relapse of the disease. The 4 patients who had not improved in the 1st week of treatment did not show improvement during subsequent follow-up on the 4th and 6th week [Figure 1].
|Figure 1: Approximately 87% patients showed improvement in symptoms and reduction in frequency of attacks of paroxysmal positional vertigo, and approximately 13% patients showed no improvement in group 1 atweek 1,4, and 6 of treatment|
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Group 2 was treated with Semont's maneuver. Out of 30 patients, 17 (approximately 57%) showed improvement in symptoms and reduction in frequency of attacks of paroxysmal positional vertigo, and 13 patients (approximately 43%) showed no improvement in 1st week of the treatment. Seventeen patients who showed improvement during the 1st week of treatment also showed improvement on follow-up on 4th and 6th week, with no relapse of disease. The 13 patients who did not show improvement during first week of treatment did not show improvement during subsequent follow up on 4th and 6th week [Figure 2]. Comparing the two groups on the basis of improvement after maneuver showed that Group 1 had greater improvement (54%) compared to group 2 (46%) [Figure 3]. Difference in the results was significant between both the groups during week 1, 4, and 6 of follow-up (P = 0.01). Hence, this study showed that Epley's maneuver was superior to Semont's maneuver in the management of BPPV.
|Figure 2: Approximately 57% patients showed improvement in symptoms and reduction in frequency of attacks of paroxysmal positional vertigo, and approximately 43% patients showed no improvement in group 2 atweek 1,4, and 6 of treatment|
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|Figure 3: Group 1 had greater improvement (54%) compared to Group 2 (46%)|
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| Discussion|| |
Vertigo and dizziness are common symptoms in the general population. A minimum of 20% of all patients complaining of vertigo have BPPV. Because of the increased incidence and prevalence of BPPV, a large number of studies have been conducted internationally regarding the effectiveness of various treating maneuvers.
Prokopakis et al.  assessed the long-term efficacy of Epley's maneuver in the treatment of patients with BPPV. A total of 544 (92%) out of 592 patients treated reported no symptoms of vertigo after 1 month revealing the efficacy of Epley's maneuver. In our study, we were also able to achieve approximately 87% cure of BPPV from Epley's maneuver.
Richard et al.  assessed the efficacy of the Epley's maneuver in a study of 81 patients with posterior semicircular canal BPPV. A group of 61 patients underwent the maneuver, where as a control group of 20 patients received no therapy. All patients were evaluated at 1 and 6 months. The percentage of patients who experienced subjective improvement was significantly higher in the treatment group at both 1 month (89% vs. 10%) and 6 months (92% vs. 50%). Three patients in the treatment group who did not improve after treatment underwent a second maneuver, and all achieved a positive result. The results of this study support our study findings regarding the efficacy of Epley's maneuver.
Pérez Vázquezet al.  conducted a study including 37 consecutive cases of BPPV treated with the Epley's maneuver. 97% of the patients improved and the maneuver was well tolerated. Ruckenstein  showed a 74% of cure rate in patients who were treated with one or two Epley maneuvers.
Lynn et al.  reported a success rate of 89% after a single treatment session with Epley's maneuver as compared with a success rate of 23% in an untreated control group. Ahmed et al. reported 79.7% recovery in BPPV patients after single treatment with Epley's maneuver. 
VazGarcia  conducted a study involving 175 patients from both the sexes. All were suffering from BPPV and were treated with Semont's maneuver. The study revealed that 1-week after Semont's maneuver, 79% of the patients were cured. The success rate of Semont's maneuver was less in our study (approximately 57%).
Pospeich  presented the results of rehabilitation with the use of Semont and Epley maneuvers in 46 patients. In their series, Semont's maneuver was successful in ameliorating the symptoms in 62% patients, while Epley maneuver benefited 73% patients. In effect, both maneuvers exhibited pretty much comparable results. In comparison, we had a far higher success rates with Epley's than with Semont's maneuver.
We observed 86.7% success with Epley's and 56.7% success with Semont's maneuver. Moreover, we observed a predominance of female patients (65%), which is also according to the literature reports.  The mean age of patients in our study in group 1 was 50.07 and in group 2 was 44.87.
| Conclusion|| |
BPPV is one of the most common causes of peripheral vertigo, and it can be easily diagnosed in out patient department by Dix Hallpike test. Epley's maneuver is more effective in the treatment of BPPV than Semont's maneuver.
The procedures performed in the course of this study involving human participants were in strict accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration.
Financial support and sponsorship
Conflicts of interest
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]