Treatment of benign positional vertigo using the semont maneuver: efficacy in patients presenting without nystagmus

Laryngoscope. 2002 May;112(5):796-801. doi: 10.1097/00005537-200205000-00006.


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 (chi2 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 (chi2 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.

Publication types

  • Evaluation Study

MeSH terms

  • Electronystagmography*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Physical Therapy Modalities*
  • Posture
  • Retreatment
  • Retrospective Studies
  • Treatment Outcome
  • Vertigo / etiology
  • Vertigo / rehabilitation*