Semont and Epley manoeuvres for vertigo

Treatment Overview

The Semont and modified Epley manoeuvres are exercises used to treat benign paroxysmal positional vertigo (BPPV). They are done with the assistance of a health professional or physiotherapist. 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 manoeuvres have been used successfully: the Semont manoeuvre and the modified Epley manoeuvre.

The Semont manoeuvre is performed as follows:

• You are seated, and the health professional turns your head 45 degrees horizontally toward the unaffected ear.
• The health professional 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 health professional then moves you quickly through the seated position, holding your head in place, until you are lying on the side of the affected 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 health professional 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 manoeuvre is performed as follows:

• You are seated, and the health professional turns your head 45 degrees horizontally toward the affected ear. You should hold the health professional’s arms for support.
• The health professional 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 health professional turns your head 90 degrees toward the unaffected ear. The health professional 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 health professional helps you back to a seated position. Then the health professional 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 manoeuvres 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.

What To Expect After Treatment

The Semont and modified Epley manoeuvres 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 manoeuvres are used to treat BPPV.

How Well It Works

Most people are free of vertigo associated with BPPV after one or two treatments using the Semont manoeuvre.

Studies suggest that the modified Epley procedure is a safe, effective way to treat BPPV. There are no long-term studies of this treatment, so experts don't know whether it keeps BPPV from coming back.¹

Risks

There are no significant risks associated with this treatment.

What To Think About

The Semont and modified Epley manoeuvres are about as effective as the other treatments for BPPV, such as exercises (for example, Brandt-Daroff exercise) that help speed up compensation by the brain. When these manoeuvres work, they can relieve symptoms of vertigo quickly.

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Author:	Kathe Gallagher, MSW	Last Updated: March 9, 2007
Medical Review:	Anne C. Poinier, MD - Internal Medicine Barrie J. Hurwitz, MD - Neurology Donald Sproule, MD, CM, CCFP, FCFP - Family Medicine Andrew Swan, MD, CCFP, FCFP - Family Medicine
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