Semont and Epley maneuvers for vertigo

Treatment Overview

The Semont and modified Epley maneuvers are exercises used to treat benign paroxysmal positional vertigo (BPPV). They are done with the assistance of a doctor or physical therapist. A single 10- to 15-minute session usually is all that is needed.

When your head is firmly moved into different positions, the calcium crystal (canalith) debris causing vertigo will slip out of the semicircular canal into an area of the inner ear where it will no longer cause symptoms. Two maneuvers have been used successfully: the Semont maneuver and the modified Epley maneuver.

The Semont maneuver is performed as follows:

• You are seated, and the doctor turns your head 45 degrees horizontally toward the unaffected ear.
• The doctor tilts you 105 degrees so that you are lying on the side of the affected ear with your head hanging and your nose pointed upward. You remain in this position for 3 minutes. The debris should move to the apex of the canal.
• The doctor then moves you quickly through the seated position, holding your head in place, until you are lying on the side of the unaffected ear with your nose pointed to the ground. You remain in this position for 3 minutes. The debris should move toward the exit of the canal.
• The doctor then slowly moves you back to the seated position. The debris should fall into the utricle of the canal, where it will not cause vertigo.

The modified Epley maneuver is performed as follows:

• You are seated, and the doctor turns your head 45 degrees horizontally toward the affected ear. You should hold the doctor's arms for support.
• The doctor tilts you backward to a horizontal position with your head kept in place at a 45-degree turn, hanging. An attack of vertigo is likely as the debris moves toward the apex of the canal. You are held in this position until the vertigo stops, usually within a minute.
• The doctor turns your head 90 degrees toward the unaffected ear. The doctor then rolls you onto the side of the unaffected ear, so that you are now looking at the floor. The debris should move in the canal again, possibly provoking another attack of vertigo. You should remain in this position until the vertigo stops, usually within a minute.
• The doctor helps you back to a seated position. Then the doctor tilts your head down 30 degrees, which allows the debris to fall into the utricle of the canal where it will not cause vertigo.

Sometimes these maneuvers are performed while you wear a vibrating headband. The vibration can help move the debris into an area of the inner ear where it will not affect balance.

In some cases, your doctor or physical therapist may have you do the modified Epley procedure at home. If your doctor has shown you how and you feel confident, you can try this at home to get rid of your vertigo.

What To Expect After Treatment

The Semont and modified Epley maneuvers may improve or cure benign paroxysmal positional vertigo (BPPV) with only one treatment. Some people need multiple treatments.

Why It Is Done

Semont and modified Epley maneuvers are used to treat BPPV.

How Well It Works

The modified Epley procedure is safe and works well to treat benign paroxysmal positional vertigo (BPPV).¹

The Semont maneuver may work to stop symptoms of BPPV. But the evidence is not as good as it is for the modified Epley procedure.¹

Risks

There are no significant risks associated with this treatment.

What To Think About

The Semont and modified Epley maneuvers are more effective than other treatments for BPPV, such as exercises (for example, the Brandt-Daroff exercise).¹ Exercises do not treat the cause of BPPV. They help speed up compensation by the brain. When the Semont and modified Epley maneuvers work, they can relieve symptoms of vertigo quickly.

Complete the special treatment information form (PDF) (What is a PDF document?) to help you understand this treatment.

References

Citations

1. Fife TD, et al. (2008). Practice parameter: Therapies for benign paroxysmal positional vertigo (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 70(22): 2067-2074.

Credits