key: cord-0724825-y4vyap5v authors: Sinsamutpadung, Chayada; Kulthaveesup, Anan title: Comparison of outcomes of the Epley and Semont maneuvers in posterior canal BPPV: A randomized controlled trial date: 2021-07-13 journal: Laryngoscope Investig Otolaryngol DOI: 10.1002/lio2.619 sha: e44f540508ba31202d2266a7d7cbd40958fba046 doc_id: 724825 cord_uid: y4vyap5v OBJECTIVES: This study aims to compare the efficacy of the Epley and Semont maneuvers in relieving posterior canal benign paroxysmal positional vertigo (BPPV) arising in the in patients at the Outpatient Department of the Department of Otolaryngology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand. METHOD: In this prospective, randomized, comparative study, patients were assigned to receive one of the two treatment methods. First, BPPV was diagnosed with the Dix‐Hallpike test. Then, each patient was treated by either the Epley or Semont maneuver. Immediately afterward, the efficacy of treatments was evaluated with the Dix‐Hallpike test, and dizziness intensity was assessed with the visual analog scale (VAS). RESULTS: This study enrolled 80 patients with posterior canal BPPV, 40 of which underwent the Epley maneuver and the other 40 underwent the Semont maneuver. In the first week, The Epley maneuver cured 37 (92.5%) of the 40 patients, and the Semont maneuver cured 36 (90%) of the 40 patients. Statistical analysis revealed no significant difference in the efficacy of these treatments (P = .251). Regarding dizziness intensity, VAS scores decreased from 6.48 to 1.65 after the Epley maneuver and from 6.53 to 2.18 after the Semont maneuver. Statistical analysis revealed that the Epley maneuver was superior to the Semont maneuver (P = .009) in reducing dizziness intensity. CONCLUSIONS: The Epley and Semont maneuvers had similar efficacy in curing posterior canal BPPV. Regarding the severity of dizziness after treatment, the Epley maneuver produced significantly better results than did the Semont maneuver. Level of Evidence: II Benign paroxysmal positional vertigo (BPPV), a common form of vertigo, is often triggered by a change in the posture of the head and affects the quality of life and daily activities of the patient. Every year, patients with BPPV seek help at the Outpatient Department of the Department of Otolaryngology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand. The disease mainly originates in the posterior semicircular canal. [1] [2] [3] [4] [5] [6] The most popular treatments are the Epley and Semont maneuvers. 7, 8 These two methods have been compared. However, available information concluding which treatment is better is insufficient. [9] [10] [11] In this study, the In addition, each participant rated the effect of dizziness using Dizziness Handicap Inventory-Thai version. 12 This was adapted from the Dizziness Handicap Inventory (DHI) of Jacobson et al. 13 The total score could range from 0 to 100, and the degree of severity was determined as follows: • A score of 0 to 39 indicated that BPPV mildly affected the activities of daily living. • A score of 40 to 69 indicated that BPPV moderately affected the activities of daily living. • A score of 70 to 100 indicated that BPPV strongly affected the activities of daily living. Then, the auditory and nervous systems were examined with a pneumatic otoscope, a tuning fork (Weber and Rinne tests), oculomotor tests, head thrust test, saccade test, Romberg's test, Tandem gait test, a test for dysdiadochokinesia, the finger-to-nose test, and the Dix-Hallpike test with Frenzel goggles. The diagnosis of BPPV was confirmed, and the affected side was recorded, as well as the presence of nystagmus (characteristic, latency, and duration). After the diagnosis of posterior semicircular canal BPPV was confirmed, the Epley maneuver was performed. For the Epley maneuver, the patient sat on the examination bed, the examiner stood behind the patient, and the assistant stood at the patient's right side. The patient turned 45 toward the affected side, lay down, and lowered the head 20 . After 60 seconds, with the patient's head still lowered, the physician turned the patient's head to the opposite side, 45 from midline. After another 60 seconds, the patient's head and body were rotated until the patient's head was positioned 135 from the supine position. After another 60 seconds, the patient sat up on the edge of the bed, still facing the unaffected side. For the Semont maneuver, the patient performed all actions, and the physician only closely supervised and observed the symptoms. The patient sat on the examination bed with feet hanging beside the bed, turned the head 45 toward the unaffected side, and then quickly lay down on the affected side and held it for 30 seconds or until nystagmus disappeared. The patient then quickly rose, lay down on the unaffected side, turned to face downward, and held this position for 30 seconds, after which the patient rose to sit on the side of the bed with the feet hanging, as before the examination. After both treatments, the Dix-Hallpike test was performed. Then, the patient was asked to complete the VAS for how much they feel dizzy immediately after treatment. After 1 week from the first treatment, the Dix-Hallpike test was repeated. Post Treatment complications, such as canal conversion and canalith jam were aware. The quantitative data (age, BMI, and severity of vertigo), the DHI before treatments, latency and duration of nystagmus were calculated either as means and SDs or as medians and interquartile ranges. Statistical correlation was tested with an independent t test or the Mann-Whitney U test; the results were considered statistically significant when P <.05. The results of the Dix-Hallpike test before and after treatment were calculated as percentages. The relationship between test results was statistically evaluated with either a chi-square test or the Fisher's exact test; the results were considered statistically significant when P <.05. DHI before and after treatment were calculated either as means and SDs or as medians and interquartile ranges. In our opinion, Both treatments have good success rate but the Epley maneuver is less dizzy at immediate post treatment. But, the good point of the Semont maneuver is that it is easy to do by themself at home. We recommend doing the Epley maneuver as treatment in an in-office situation and Semont maneuver for patients who cannot reach a hospital or clinic such as tele-medicine in a remote area, needs quarantine due to covid-19 or patient in negative-pressure room. At present, there are many studies about Self-administered Epley maneuver. Radke et al showed success rate at 95% of the Selfadministered Epley maneuver group compared with 58% of the Semont maneuver group. Self-administered Epley maneuver is a new treatment that includes the advantage of both Epley and Semont maneuver together (good success rate and Self-administered) but needs to focus on how to advise patients to do it correctly at home. 23,24 There was no statistically significant difference in the results of treatment of BPPV by the Semont maneuver and the Epley maneuver. Regarding the severity of dizziness after treatment, the Epley maneuver produced significantly better results than did the Semont maneuver. However, these findings are only preliminary, and further studies with larger sample sizes and compared with Self-administered Epley maneuver are needed. Diagnosis and management of lateral semicircular canal benign paroxysmal positional vertigo What is the true incidence of horizontal semicircular canal benign paroxysmal positional vertigo? Otolaryngol Head Neck Surg Benign paroxysmal positional vertigo of the horizontal canal Horizontal canal benign positional vertigo Nystagmus while recumbent in horizontal canal benign paroxysmal positional vertigo Epidemiological data from 2270 PPV patients The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo Curing the BPPV with a liberatory maneuver The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo Comparison of repositioning maneuvers for benign paroxysmal positional vertigo of posterior semicircular canal: advantages of hybrid maneuver Efficacy of Semont manoeuvre versus Epley manoeuvre in benign paroxysmal positional vertigo Translation and validity of the Thai version of the Dizziness Handicap Inventory The development of the Dizziness Handicap Inventory Canalith repositioning maneuver for benign paroxysmal positional vertigo: randomized controlled trial in family practice A randomized trial of the canalith repositioning procedure The efficacy of Epley procedure for treatment of benign paroxysmal positional vertigo of the posterior semicircular canal Clinical efficacy of Epley procedure for treatment of benign paroxysmal positional vertigo of posterior semicircular canal Particle repositioning maneuver versus Brandt-Daroff exercise for treatment of unilateral idiopathic BPPV of the posterior semicircular canal: a randomized prospective clinical trial with short-and long-term outcome The canalith repositioning procedure for the treatment of benign paroxysmal positional vertigo: a randomized controlled trial Short-term efficacy of Semont maneuver for benign paroxysmal positional vertigo: a double-blind randomized trial Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) Effect of repositioning maneuver type and postmaneuver restrictions on vertigo and dizziness in benign positional paroxysmal vertigo A modified Epley's procedure for self-treatment of benign paroxysmal positional vertigo Self-treatment of benign paroxysmal positional vertigo: Semont maneuver vs Epley procedure How to cite this article: Sinsamutpadung C, Kulthaveesup A. Comparison of outcomes of the Epley and Semont maneuvers in posterior canal BPPV: A randomized controlled trial The authors declare no potential conflict of interest. https://orcid.org/0000-0002-7039-7264Anan Kulthaveesup https://orcid.org/0000-0002-2642-4501