Semont-plus vs. Epley maneuver in BPPV
Trial question
Is Semont-plus maneuver superior to Epley maneuver in patients with posterior canal benign paroxysmal positional vertigo?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
64.0% female
36.0% male
N = 195
195 patients (125 female, 70 male).
Inclusion criteria: adult patients with posterior canal benign paroxysmal positional vertigo canalolithiasis.
Key exclusion criteria: age < 18 years; inability to consent; unwilling/unable to perform the assigned maneuver.
Interventions
N=98 Semont-plus maneuver (head 60 degrees overextended, maneuver performed once by a physician and afterward 9 times per day by the patient).
N=97 Epley maneuver (maneuver performed once by a physician and afterward 9 times per day by the patient).
Primary outcome
Number of days until no positional vertigo could be induced on 3 consecutive mornings
2 days
3.3 days
3.3 days
2.5 days
1.6 days
0.8 days
0.0 days
Semont-plus
maneuver
Epley
maneuver
Significant
decrease ▼
Significant decrease in the number of days until no positional vertigo could be induced on 3 consecutive mornings (2 days vs. 3.3 days; AD -1.3 days, 95% CI -2.29 to -0.31).
Secondary outcomes
No significant difference in effect of a single therapeutic maneuver (68.4% vs. 62.9%; AD 5.5%, 95% CI -7.65 to 18.65).
Safety outcomes
No significant difference in nausea.
Conclusion
In adult patients with posterior canal benign paroxysmal positional vertigo canalolithiasis, Semont-plus maneuver was superior to Epley maneuver with respect to number of days until no positional vertigo could be induced on 3 consecutive mornings.
Reference
Michael Strupp, Marco Mandala, Anne-Sophie Vinck et al. The Semont-Plus Maneuver or the Epley Maneuver in Posterior Canal Benign Paroxysmal Positional Vertigo: A Randomized Clinical Study. JAMA Neurol. 2023 Aug 1;80(8):798-804.
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