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Epley and Semont Maneuvers for Vertigo

Treatment Overview

The Epley and Semont 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 Epley maneuver and the Semont maneuver.

The 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.

The Semont maneuver is performed as follows:

  • You are seated, and the doctor turns your head so that it is halfway between looking straight ahead and looking away from the side that causes the worst vertigo.
  • The doctor then lowers you quickly to the side that causes the worst vertigo. When your head is on the table, you are looking up at the ceiling. The doctor holds you in this position for 30 seconds.
  • The doctor then quickly moves you to the other side of the table without stopping in the upright position. When your head is on the table, you are now looking down at the table. The doctor holds you in this position for 30 seconds.
  • The doctor then helps you sit back up.

In some cases, your doctor or physical therapist may have you do a 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 Epley and Semont maneuvers may improve or cure benign paroxysmal positional vertigo (BPPV) with only one treatment. Some people need multiple treatments.

Why It Is Done

Epley and Semont maneuvers are used to treat BPPV.

How Well It Works

The 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 Epley procedure.1

Risks

These maneuvers should not be done on people with back or spine injuries or problems.

Sometimes the maneuver can move the debris from one inner ear canal to another. This can cause a different kind of vertigo.

What To Think About

The Epley and Semont 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 Epley and Semont maneuvers work, they can relieve symptoms of vertigo quickly.

If the Epley and Semont maneuvers don't work to relieve your symptoms of vertigo, you may not have the most common type of BPPV. Or you may not have BPPV at all.

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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

By Healthwise Staff
Anne C. Poinier, MD - Internal Medicine
E. Gregory Thompson, MD - Internal Medicine
Last Revised December 19, 2012

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