Switch to Semont maneuver is no better than repetition of Epley maneuver in treating refractory BPPV
The objectives of this study is to compare the efficacy between repetition of Epley maneuver and switch to alternate Semont maneuver in treating posterior canal benign paroxysmal positional vertigo (PC-BPPV) that does not respond to the initial Epley maneuver. In the nationwide, seven dizziness clinics of Korea, 506 consecutive patients (303 women, age range 22–87, mean age ± SD = 64 ± 12, median = 61) with idiopathic PC-BPPV were initially treated with a single Epley maneuver. Of those, 144 (28.5%) patients, who did not respond to the therapy, were randomized to the repetition of Epley maneuver (n = 70) or switch to Semont maneuver (n = 74). The therapeutic efficacy was determined within 1 h by a blinded examiner after the trial of each second maneuver. The efficacy did not differ between the repetition of Epley maneuver and switch to Semont maneuver groups (38.6 vs. 27.0%, p = 0.14, Chi-square test). However, the patients with a long duration (p < 0.001, linear regression) and latency (p = 0.01) of the positional nystagmus during Dix–Hallpike maneuver showed a higher rate of the initial and second treatment failures. Either Epley or Semont maneuver may be applied as a second treatment to the patients with PC-BPPV refractory to the initial Epley maneuver. This study provides Class I evidence that repeated Epley and switch to Semont maneuver shows a similar efficacy in treating PC-BPPV that does not respond to the initial Epley maneuver.
Clinical trial registration: NCT01822002.
KeywordsVertigo Nystagmus BPPV, benign paroxysmal positional vertigo PC-BPPV, BPPV involving the posterior semicircular canal Epley maneuver Semont maneuver Treatment outcome Double-blind randomized trial Vestibular
This study is supported by Grant of the Korea Healthcare technology R&D Project, Ministry of Health and Welfare, Republic of Korea (HI16C0429), and by fund of Research Institute of Clinical Medicine, Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital.
S-YO, as the first author, contributed to data collection, data analysis, interpretation of the data, and drafting and revision of the manuscript. JSK, as the corresponding author, contributed to the design and conceptualizing of the study, interpretation of the data, analysis of data, and revision of the manuscript. SHL, J-YP, H-SL, T-HY, contributed to data collection, data analysis, interpretation of the data, and revision of the manuscript. S-HJ, K-DC, and H-JK contributed to data collection, interpretation of the data, and revision of the manuscript.
Compliance with ethical standards
Conflicts of interest
Dr. J.S. Kim is supported by Grant of the Korea Healthcare technology R&D Project, Ministry of Health and Welfare, Republic of Korea (HI10C2020). Dr. S.-Y. Oh is supported by fund of Research Institute of Clinical Medicine, Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital. Dr. S.-H. Lee, K.-D. Choi, MD., J.-Y. Park, DM., T.-H. Yang, MD., S.-H. Jeong, K.-D. Choi, and M.Sc. H.J. Kim report no disclosures.
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