Treatment of Benign Positional Vertigo Using the Semont Maneuver: Efficacy in Patients Presenting Without Nystagmus

Authors

  • David S. Haynes MD,

    Corresponding author
    1. Vanderbilt Bill Wilkerson Center for Otolaryngology and Communicative Sciences, Nashville, Tennessee, U.S.A.
    • David S. Haynes, MD, S-100 Medical Center North, Vanderbilt University Medical Center, Nashville, TN 37232-2559, U.S.A.
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  • John R. Resser MD,

    1. Vanderbilt Bill Wilkerson Center for Otolaryngology and Communicative Sciences, Nashville, Tennessee, U.S.A.
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  • Robert F. Labadie MD, PhD,

    1. Vanderbilt Bill Wilkerson Center for Otolaryngology and Communicative Sciences, Nashville, Tennessee, U.S.A.
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  • Christopher R. Girasole BS,

    1. Vanderbilt Bill Wilkerson Center for Otolaryngology and Communicative Sciences, Nashville, Tennessee, U.S.A.
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  • Bradley T. Kovach BS,

    1. Vanderbilt Bill Wilkerson Center for Otolaryngology and Communicative Sciences, Nashville, Tennessee, U.S.A.
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  • Luis E. Scheker BS,

    1. Vanderbilt Bill Wilkerson Center for Otolaryngology and Communicative Sciences, Nashville, Tennessee, U.S.A.
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  • Donald C. Walker BS

    1. Vanderbilt Bill Wilkerson Center for Otolaryngology and Communicative Sciences, Nashville, Tennessee, U.S.A.
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  • Presented at the Meeting of the Southern Section of the Triologic Society, St. Pete's Beach, FL, January 14, 2000.

Abstract

Objective To evaluate and compare the efficacy of the Semont liberatory maneuver on “objective” benign paroxysmal positional vertigo (BPPV) defined as vertigo with geotropic nystagmus in Dix-Hallpike positioning versus “subjective” BPPV defined as vertigo without nystagmus in Dix-Hallpike positioning.

Study Design Retrospective chart review.

Methods One hundred sixty-two patients with positional vertigo during Dix- Hallpike positioning were identified. Patients were evaluated for the presence or absence of nystagmus. All patients underwent the Semont liberatory maneuver. The patient's condition at follow-up was documented at 3 weeks as complete, partial, or failure. Repeated procedures were performed if necessary.

Results There were 127 cases of objective BPPV and 35 cases of subjective BPPV. Overall, 90% of all patients tested had significant improvement of their vertigo after 1.49 maneuvers on average. Improvement was seen in 91% of patients with objective BPPV after 1.59 maneuvers on average, compared with 86% in subjective BPPV after 1.13 maneuvers on average (χ2 test, not significant [P = .5]). Patients with a history of traumatic origin or cause had an overall success rate of 81% compared with 92% for nontraumatic causes or origins (χ2 test, not significant [P = .1]). Recurrences were seen in 29% of patients after a successful initial maneuver; however, 96% of these patients responded to further maneuvers. Four patients with persistent symptoms after conservative management underwent posterior semicircular canal occlusion with resolution of symptoms.

Conclusion The Semont liberatory maneuver provides relief of vertigo in patients with positional vertigo, even in patients without objective nystagmus.

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