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Treatment of apogeotropic benign positional vertigo: comparison of therapeutic head-shaking and modified Semont maneuver

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Abstract

Several methods of physiotherapy have been advanced for apogeotropic type benign positional vertigo involving the horizontal semicircular canal (HC-BPV). The aim of this study was to determine the therapeutic efficacies of the proposed maneuvers in apogeotropic HC-BPV. Using a prospective randomized trial involving seven nationwide dizziness clinics in Korea, we compared the immediate efficacies of head-shaking and modified Semont maneuvers in 103 consecutive patients with apogeotropic HC-BPV. We also determined an additional therapeutic benefit of mastoid oscillation while the patients without response to both maneuvers were performing the Brandt–Daroff exercise. Successful treatment was defined as resolution of positional vertigo and nystagmus, or as transition into geotropic HC-BPV. Results showed that head shaking was more effective than the modified Semont maneuver (37.3 vs. 17.3%, P = 0.02). However, therapeutic efficacy did not differ between the maneuvers after the initial non-responders switched over to the other maneuver (23.3 vs. 25.0%, P = 0.861). Mastoid oscillation provided no additional benefit while the patients without response to both maneuvers were performing the Brandt–Daroff exercise. Most positional vertigos resolved within a week (89.4%) irrespective of the treatment modalities applied and all showed resolution within 28 days. The head-shaking maneuver described here proved more effective than the modified Semont maneuver in treating apogeotropic HC-BPV. Mastoid vibration conferred no additional benefit during the Brandt–Daroff exercise.

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Acknowledgments

This study was supported by grant no 03-2007-002 from the SNUBH Research Fund.

Conflict of interest statement

The authors report no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Neurology, School of Medicine, Chonbuk National University, Jeonju, South Korea

    S.-Y. Oh

  2. Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea

    Ji-Soo Kim & Y.-M. Oh

  3. Chungnam National University, Taejon, South Korea

    S.-H. Jeong

  4. Pusan National University, Pusan, South Korea

    K.-D. Choi

  5. Eulji University, Seoul, Korea

    B.-K. Kim

  6. Chonnam National University, Gwangju, Korea

    S.-H. Lee

  7. Won-Kwang University, Iksan, South Korea

    H.-S. Lee

  8. Dae-Dong General Hospital, Dongnae-gu, Pusan, Korea

    I.-S. Moon

  9. Sejong General Hospital, Puchon City, South Korea

    J.-J. Lee

Authors
  1. S.-Y. Oh
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  2. Ji-Soo Kim
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  3. S.-H. Jeong
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  4. Y.-M. Oh
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  5. K.-D. Choi
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  6. B.-K. Kim
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  7. S.-H. Lee
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  8. H.-S. Lee
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  9. I.-S. Moon
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  10. J.-J. Lee
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Corresponding author

Correspondence to Ji-Soo Kim.

Additional information

S.-Y. Oh (Department of Neurology, School of Medicine, Chonbuk National University) conducted the statistical analyses.

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Oh, SY., Kim, JS., Jeong, SH. et al. Treatment of apogeotropic benign positional vertigo: comparison of therapeutic head-shaking and modified Semont maneuver. J Neurol 256, 1330–1336 (2009). https://doi.org/10.1007/s00415-009-5122-6

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  • DOI: https://doi.org/10.1007/s00415-009-5122-6

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