By Marcello Cherchi, MD PhD
The Semont maneuver was first described by Dr. Alain Semont and colleagues (Semont et al. 1988). This is probably the second most commonly performed maneuver for posterior canal BPPV.
The Figure below shows the left-sided Semont maneuver for left-sided posterior canal benign paroxysmal positional vertigo, from Radtke and colleagues (Radtke et al. 2004).
The Semont maneuver for treating left-sided posterior canal BPPV can be described as follows.
- The patient starts in a seated neutral position.
- The patient turns the head 45 degrees toward the unaffected (right) side.
- The patient lies down on the affected (left) shoulder, maintaining the head turned 45 degrees toward the unaffected (right) side, such that the nose is pointing half-way between the earth’s surface and the sky. This position is maintained for 1 minute.
- The patient quickly swings 180 degrees toward the unaffected (right) side (passing through a seated position), into a position lying on the unaffected (right) shoulder, maintaining the head turned 45 degrees toward the unaffected (right) side, such that the nose is pointing half-way between the earth’s surface and the ground. This position is maintained for 1 minute.
- The patient slowly gets back up into a seated neutral position.
Semont maneuver, left posterior canal, videos
- https://www.youtube.com/watch?v=ZKq8RL0mNUA (Wendy Carender, University of Michigan)
- https://www.youtube.com/watch?v=AT9fDzo34bk (Boys Town)
- https://www.youtube.com/watch?v=7KeT8nwCfIA (Dr. Michael Teichido)
The Semont maneuver (Semont et al. 1988) has been studied in multiple prospective trials:
- With no control group (Semont et al. 1988).
- Against no treatment (Salvinelli et al. 2003).
The Semont maneuver has been studied in multiple prospective randomized trials:
- Against a sham maneuver (Chen et al. 2012; Lee et al. 2014; Mandala et al. 2012).
- Against the Epley maneuver (Celis-Aguilar et al. 2022; Lee et al. 2014; Sinsamutpadung and Kulthaveesup 2021; Soto Varela et al. 2001; Thakur et al. 2024).
- Against the Brandt-Daroff maneuver (Celis-Aguilar et al. 2022; Soto Varela et al. 2001).
Modifications of the Semont maneuver have also been studied in prospective randomized trials:
- Against the Epley maneuver (Cohen and Jerabek 1999; Radtke et al. 2004).
- Against a modified Epley maneuver (Cohen and Jerabek 1999).
- The SemontPlus maneuver has been compared against the regular Semont maneuver (Strupp et al. 2021; Strupp et al. 2023).
The Semont maneuver has also been studied in multiple systematic reviews (Valsted et al. 2024; White et al. 2005).
References
Celis-Aguilar E, Mayoral-Flores HO, Torrontegui-Zazueta LA, Medina-Cabrera CA, Leon-Leyva IC, Dehesa-Lopez E (2022) Effectiveness of Brandt Daroff, Semont and Epley maneuvers in the treatment of Benign Paroxysmal Positional Vertigo: A Randomized Controlled Clinical Trial. Indian J Otolaryngol Head Neck Surg 74: 314-321. doi: 10.1007/s12070-021-02516-w
Chen Y, Zhuang J, Zhang L, Li Y, Jin Z, Zhao Z, Zhao Y, Zhou H (2012) Short-term efficacy of Semont maneuver for benign paroxysmal positional vertigo: a double-blind randomized trial. Otol Neurotol 33: 1127-30. doi: 10.1097/MAO.0b013e31826352ca
Cohen HS, Jerabek J (1999) Efficacy of treatments for posterior canal benign paroxysmal positional vertigo. Laryngoscope 109: 584-90. doi: 10.1097/00005537-199904000-00012
Kim JS, Zee DS (2014) Clinical practice. Benign paroxysmal positional vertigo. N Engl J Med 370: 1138-47. doi: 10.1056/NEJMcp1309481
Lee JD, Shim DB, Park HJ, Song CI, Kim MB, Kim CH, Byun JY, Hong SK, Kim TS, Park KH, Seo JH, Shim BS, Lee JH, Lim HW, Jeon EJ (2014) A multicenter randomized double-blind study: comparison of the Epley, Semont, and sham maneuvers for the treatment of posterior canal benign paroxysmal positional vertigo. Audiol Neurootol 19: 336-41. doi: 10.1159/000365438
Mandala M, Santoro GP, Asprella Libonati G, Casani AP, Faralli M, Giannoni B, Gufoni M, Marcelli V, Marchetti P, Pepponi E, Vannucchi P, Nuti D (2012) Double-blind randomized trial on short-term efficacy of the Semont maneuver for the treatment of posterior canal benign paroxysmal positional vertigo. J Neurol 259: 882-5. doi: 10.1007/s00415-011-6272-x
Radtke A, von Brevern M, Tiel-Wilck K, Mainz-Perchalla A, Neuhauser H, Lempert T (2004) Self-treatment of benign paroxysmal positional vertigo: Semont maneuver vs Epley procedure. Neurology 63: 150-2. doi: 10.1212/01.wnl.0000130250.62842.c9
Salvinelli F, Casale M, Trivelli M, D’Ascanio L, Firrisi L, Lamanna F, Greco F, Costantino S (2003) Benign paroxysmal positional vertigo: a comparative prospective study on the efficacy of Semont’s maneuver and no treatment strategy. Clin Ter 154: 7-11.
Semont A, Freyss G, Vitte E (1988) Curing the BPPV with a liberatory maneuver. Adv Otorhinolaryngol 42: 290-3. doi: 10.1159/000416126
Sinsamutpadung C, Kulthaveesup A (2021) Comparison of outcomes of the Epley and Semont maneuvers in posterior canal BPPV: A randomized controlled trial. Laryngoscope Investig Otolaryngol 6: 866-871. doi: 10.1002/lio2.619
Soto Varela A, Bartual Magro J, Santos Perez S, Velez Regueiro M, Lechuga Garcia R, Perez-Carro Rios A, Caballero L (2001) Benign paroxysmal vertigo: a comparative prospective study of the efficacy of Brandt and Daroff exercises, Semont and Epley maneuver. Rev Laryngol Otol Rhinol (Bord) 122: 179-83.
Strupp M, Goldschagg N, Vinck AS, Bayer O, Vandenbroeck S, Salerni L, Hennig A, Obrist D, Mandala M (2021) BPPV: Comparison of the SemontPLUS With the Semont Maneuver: A Prospective Randomized Trial. Front Neurol 12: 652573. doi: 10.3389/fneur.2021.652573
Strupp M, Mandala M, Vinck AS, Van Breda L, Salerni L, Gerb J, Bayer O, Mavrodiev V, Goldschagg N (2023) The Semont-Plus Maneuver or the Epley Maneuver in Posterior Canal Benign Paroxysmal Positional Vertigo: A Randomized Clinical Study. JAMA Neurol 80: 798-804. doi: 10.1001/jamaneurol.2023.1408
Thakur B, Raj P, Singh K, Anand V (2024) To compare the recovery rates of modified Epley’s against Semont’s manoeuvres in patients with posterior canal benign paroxysmal positional vertigo: a randomized clinical trial. Eur Arch Otorhinolaryngol 281: 4641-4648. doi: 10.1007/s00405-024-08657-2
Valsted SS, Larsen AT, Callesen HE, Hougaard DD (2024) A Comparison of the Efficacy of Four Repositioning Maneuvers in the Treatment of Posterior Benign Paroxysmal Positional Vertigo. Am J Audiol 33: 1008-1022. doi: 10.1044/2024_AJA-23-00177
White J, Savvides P, Cherian N, Oas J (2005) Canalith repositioning for benign paroxysmal positional vertigo. Otol Neurotol 26: 704-10. doi: 10.1097/01.mao.0000178128.66482.7e
