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Year : 2020  |  Volume : 26  |  Issue : 4  |  Page : 211-214

Comparative study of epley's and semont's maneuver in treatment of benign paroxysmal positional vertigo in a tertiary care hospital

Department of ENT and HNS, VIMSAR, Sambalpur, Odisha, India

Date of Submission15-Aug-2020
Date of Decision02-Oct-2020
Date of Acceptance28-Oct-2020
Date of Web Publication23-Apr-2021

Correspondence Address:
Dr. Sabyasachi Biswal
At- Sadeipali, P.O Burla, Sambalpur - 768 017, Odisha
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/indianjotol.INDIANJOTOL_182_20

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Introduction: Benign paroxysmal positional vertigo (BPPV) is the most common cause of true vertigo resulting from displacement of otoconia into the semicircular canals. Both Epley's and Semont's maneuver have been used since decades with rewarding results. Aim: This study aims to compare the efficacy between the two methods in inducing remission of symptoms and preventing relapse. Materials and Methods: This study has been done in department of ear, nose, throat, and head and neck surgery of a rural tertiary care hospital in India with 10 month duration from April 2019 to February 2020. Sixty-six diagnosed cases of BPPV were included in the study and two groups were created. First group (A) included those 33 patients treated with Epley's and other group (B) included the rest 33 patients those had been treated by Semont's maneuver and the results compared. We excluded the patients having central or other peripheral causes of vertigo and those suffering from cervical spondilopathy. Data collected as entered into Microsoft office excel 2013 and were analyzed using SPSS 20.0 [IBM, New York, USA]. Chi-square test applied and statistical significance was set at P ≤ 0.05. Results: Both the treatments showed relief of symptom within 1st week of treatment. Thirty patients of Group A out of 33 (90.9%) o and 22 patients of group B out of 33 (67%) got relieved from symptoms. Patients followed up for 6 months post treatment for recurrence and it was found that 3 patients in group A and 6 patients in group B showed relapse of symptoms requiring further treatment. Conclusion: Both methods efficient in treating BPPV with Epley's maneuver relatively more effective than Semont's in terms of remission (statistically significant with P = 0.016 and both maneuvers gave similar results in terms of relapse.

Keywords: Benign paroxysmal positional vertigo, Eple's maneuver, Semont's manoeuvre, vertigo

How to cite this article:
Acharya S, Biswal S, Dash S, Aparajita A. Comparative study of epley's and semont's maneuver in treatment of benign paroxysmal positional vertigo in a tertiary care hospital. Indian J Otol 2020;26:211-4

How to cite this URL:
Acharya S, Biswal S, Dash S, Aparajita A. Comparative study of epley's and semont's maneuver in treatment of benign paroxysmal positional vertigo in a tertiary care hospital. Indian J Otol [serial online] 2020 [cited 2021 Oct 23];26:211-4. Available from: https://www.indianjotol.org/text.asp?2020/26/4/211/314344

  Introduction Top

Vertigo is a debilitating common symptom occurring from various disorders of auditory and neurological diseases. Benign paroxysmal positional vertigo (BPPV) is the most common among them with a lifetime prevalence of 2.4%.[1] BPPV can reduce the quality of life in the elderly patients with episodes of falls leading to decreased activity and depression.[2] BPPV is characterized by intense vertigo that comes in paroxysms in certain head positions and last for few seconds.[3] Pathology lies in displacement of otoconia from the utricle into the semicircular canals. The condition is mostly idiopathic but Possible secondary causes are head injury, vestibular neuritis, otosclerosis, Meniere's disease, etc., Posterior canal involvement in BPPV is the most common due to anatomical reasons that is being more dependent in both supine or erect position.[4] Anterior canal type is extremely rare. It is diagnosed clinically by typical symptoms and observing characteristic torsional nystagmus in Dix-Hallpike maneuver. Treatment is by repositioning the otoconias back into utricle by various canal repositioning maneuvers[5] such as Epley's, Brandt–Daroff or by liberatory maneuvers like Semont et al.[6]

Eply's maneuver the maneuver consists of five positions:

  • Position 1: With the head turned 45° to affected side, the patient is made to lie down in head-hanging position by 30° extension
  • Position 2: Head is now turned 90° to the opposite side so that affected ear is up
  • Position 3: The whole body and head are now rotated away from the affected ear to a lateral recumbent position so that the patient looks obliquely downwards
  • Position 4: Patient is now brought to a sitting position with head still turned to the unaffected side by 45°
  • Position 5: The head is now turned forward and chin brought down 20°.

Semont's maneuver

  • Patient lying on the affected side from a seated position, with the face turned upwards 45° away from the affected canal
  • The patient is quickly swung through the sitting position without pausing to the opposite side
  • The head position relative to the shoulder remains unchanged and maintained for 5 min
  • The patient then slowly resumes the sitting position.

We hereby performed a comparative study of both these maneuvers those are used in treatment of BPPV.


The aim of the study is to compare the efficacy of Epley's and Semont's maneuver in the treatment of BPPV in terms of symptom remission and preventing relapse.

  Materials and Methods Top

The hospital-based prospective observational study was conducted at department of ear, nose, throat (ENT) and head and neck surgery of a rural tertiary care hospital. Study was done between April 2019 and February 2020. The study population was clinically diagnosed BPPV patients coming to ENT outpatient department. We included patients of age 15 years to 65 years and cases where characteristic torsional nystagmus was elicited in the Dix-Hallpike maneuver with typical features of latency and fatigability. We excluded the patients those were having severe cervical spondylopathy, patients with cervical spine injury and patients complaining of vertigo but where diagnosis other than BPPV had been made. We included total 66 cases in our study in a span of 10 months. X-ray cervical spine done in all patients before treatment to exclude cervical spine disease. All patients were explained about the study and written informed consent was obtained for the same. All patients divided into two equal groups A and B as per the treatment they received.

Those patients treated by Epley's maneuver were placed in group A and those patients treated with Semont's maneuver were placed in Group B. Post maneuver all patients were treated with vestibular sedatives for 3 days and were advised postural restriction and to maintain upright position for 48 h. Maneuvers were repeated up to 3 times as per the response. Patients were advised for follow-up for the next 6 months.

  Observation and Results Top

The mean age of patients of Group A is 48.3 years and that of Group B is 49.8 years showing the difference of age between the two study populations is not significant. In group A consists of 21 females and 12 males and Group B consists of 20 females and 13 males which shows both the groups are also gender compatible [Table 1].
Table 1: Gender distribution of both the groups

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Both the groups showed promising results. 30 patients of Group A (91%) and 22 patients of Group B (67%) got relief from symptoms within 1st week of treatment. Three (1%) patients in Group A and 6 (1.8%) patients in Group B showed relapse of symptoms requiring further treatment [Figure 1] and [Table 2].
Figure 1: Bar showing the percentage of patients showing symptom remission and relapse of both groups

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Table 2: The number of patients with symptom remission and relapse in both groups

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The results from both the groups compared where the Group A showed higher percentage of symptom remission that is 91% than Group B, i.e., 67%. Chi-square test was applied and significance level of the difference in result between the two forms of treatments was set at P ≤ 0.05.

Result showed Chi-square statistics at 5.8022 with P = 0.016 (significant).

While calculating the same to determine the significance of the result showing difference between the two forms of treatments in terms of preventing relapse Chi-square statistics at 1.1579 and P = 0.2819 (Not significant).

  Discussion Top

It is evident from the study both the maneuvers are quite effective in treating the patients of BPPV and have been traditionally used in treatment of BPPV. But Eply's maneuver showed more efficacies in symptom remission when compared to Semont's maneuver. And when it comes to prevent relapse, both maneuvers showed statistically similar results. All 3 in Group A and 8 out of 11 in group B those failed to respond are from the age group 45 to 65 [Table 3] and [Table 4]. Hence, in our observation advancing age may be a separate entity influencing outcome that may be due to other attributable factors like vertebrobasilar insufficiency in patients of these age groups. All 3 patients of Group A and 4 out of 6 patients of Group B those had relapse of symptom are <35 years. This may be attributable to hyperactivity and reposition of otoconia back in the canals in these young people. Remission and relapse are not affected by gender as evident from study.
Table 3: Failure rate in different age groups in Group A

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Table 4: Failure rate in different age groups in Group B

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The disease is more prevalent in females as seen in the study. Similar observation of female predominance is also seen in study conducted by Salvinelli et al., Neuhauser and Lempert.[4],[7],[8]

Lynn et al. reported a success rate of 89% with Epley's maneuver[9] and Ahmed et al. reported 79.7% recovery in BPPV patients after single treatment with Epley's maneuver that resembles 84% in our study.

A similar study done by Sen et al. showed Epley's maneuver as more efficient in treating BPPV than Semont's maneuver. They observed 86.7% success with Epley's maneuver and 56.7% success with Semont's maneuver.[10]

Prokopakis et al. reported 92% success in remission from vertigo by Epley's maneuver after 1 month of treatment[11] that is close to our result with the Eply's maneuver.

VazGarcia conducted a study on 175 patients those suffering from BPPV and treated them with Semont's maneuver. It was revealed that 79% of the patients were cured after 1 week of the treatment.[12]

Majeed et al. however found no statistically significant difference between Epley's and Semont's maneuvers in treating BPPV patients where they had 82% patients recovered completely with Epley's and 78% patients recovered after treatment with Semont's maneuver.[13]

All above studies were done taking the parameter of symptom remission into consideration but we studied both maneuvers in terms of symptom remission and prevention of relapse.

No procedure is immune to adverse effect. During both the procedures adverse effect like gait instability noted in some patients for a brief period that got subsided on its own. In 1 patient of Group A, nystagmus converted into rapid form [Figure 2] and [Figure 3].
Figure 2: Pie-chart showing adverse events in Group A

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Figure 3: Pie-chart showing adverse events in Group B

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  Conclusion Top

So from the above observational prospective study, it is evident that both the maneuvers are effective in treatment of BPPV and Epley's maneuver gives superior results than Semont's maneuver in terms of symptoms remission while both are statistically similarly efficacious in preventing the relapse of symptoms. Semont's maneuver is a better option in dealing with patients with cervical spine disease in whom passive neck movements are restricted.[7],[14]

Ethical approval

The study was conducted after obtaining due approval from institutional ethics committee.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Scott-Brown's Otorhinolaryngology, Head & Neck surgery. 8th ed. London: CRC Press; 2018. p. 831-41.  Back to cited text no. 1
Oghalai JS, Manolidis S, Barth JL, Stewart MG, Jenkins HA. Unrecognized benign paroxysmal positional vertigo in elderly patients. Otolaryngol Head Neck Surg 2000;122:630-4.  Back to cited text no. 2
Dhingra PL. Disease of ear, nose and throat and head and neck surgery. 7th ed. New Delhi: Elsevier; 2018. p. 47-8.  Back to cited text no. 3
Ajayan PV, Aleena PF, Jacob AM. Epley's maneuver versus Semont's maneuver in treatment of posterior canal benign positional paroxysmal vertigo. Int J Res Med Sci 2017;5:2854-60.  Back to cited text no. 4
Mujeeb M, Khan N. Epley's manoeuvre: Treatment of choice for benign paroxysmal positional vertigo. J Laryngol Otol 2000;114:844-7.  Back to cited text no. 5
Semont A, Freyss G, Vitte E. Curing the BPPV with a liberatory maneuver. In: Clinical Testing of the Vestibular System. Basel, Switzerland: Karger Publishers; 1988. p. 290-3.  Back to cited text no. 6
Salvinelli F, Firrisi L, Casale M, Trivelli M, D'Ascanio L, Lamanna F, et al. Benign paroxysmal positional vertigo: Diagnosis and treatment. Clin Ter 2004;155:395-400.  Back to cited text no. 7
Neuhauser H, Lempert T. Vertigo and dizziness related to migraine: A diagnostic challenge. Cephalalgia 2004;24:83-91.  Back to cited text no. 8
Lynn S, Pool A, Rose D, Brey R, Suman V. Randomized trial of the canalith repositioning procedure. Otolaryngol Head Neck Surg 1995;113:712-20.  Back to cited text no. 9
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.  Back to cited text no. 10
  [Full text]  
Prokopakis EP, Chimona T, Tsagournisakis M, Christodoulou P, Hirsch BE, Lachanas VA, et al. Benign paroxysmal positional vertigo: 10-year experience in treating 592 patients with canalith repositioning procedure. Laryngoscope 2005;115:1667-71.  Back to cited text no. 11
Vaz Garcia F. Treatment failures in benign paroxysmal positional vertigo. Role of vestibular rehabilitation. Rev Laryngol Otol Rhinol 2005;126:271-4.  Back to cited text no. 12
Majeed MA, Haq AU, Shabbir SM, Raza SN. Clinical comparative study of efficacy of Epley manoeuvre and Semont manoeuvre in benign paroxysmal positional vertigo. Pak Armed Forces Med J 2015;65:42-7.  Back to cited text no. 13
Rashad UM. Patients with benign paroxysmal positional vertigo and cervical spine problems: Is Epley's manoeuvre contraindicated, and is a proposed new manoeuvre effective and safer? J Laryngol Otol 2010;124:1167-71.  Back to cited text no. 14


  [Figure 1], [Figure 2], [Figure 3]

  [Table 1], [Table 2], [Table 3], [Table 4]


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