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Semont Maneuver for BPPV

For practitioners.

Timothy C. Hain, MD Page last modified: February 7, 2015

Ear Rocks

The Semont maneuvers, named after its inventor, Dr. Alain Semont, is intended to move debris or "ear rocks" out of the sensitive part of the ear (posterior canal) to a less sensitive location. It takes about 15 minutes to complete.

Semont

The Semont maneuver (also called the "liberatory" maneuver) involves a procedure whereby the patient is rapidly moved from lying on one side to lying on the other (Levrat et al, 2003). On the diagram above, one starts upright (A), goes to "bad" Dix-Hallpike side (B), then one is rapidly "flipped" to "bad" side down (C), one remains there for a few minutes, and then sits back up.

Supplemental material on the site DVD: Movie of the Semont Maneuver

It is a brisk maneuver that is not currently favored in the United States, but it is 90% effective after 4 treatment sessions. In our opinion, it is equivalent to the Epley maneuver as the head orientation with respect to gravity is very similar.

After the Semont maneuver, you should give patients the instructions below, which are aimed at reducing the chance that debris might fall back into the sensitive back part of the ear.

There is a home version of the Semont, which we do not recommend as in the original study, it was not very effective.


INSTRUCTIONS FOR PATIENTS AFTER OFFICE TREATMENTS (Epley or Semont maneuvers)

1. Wait for 10 minutes after the maneuver is performed before going home. This is to avoid "quick spins," or brief bursts of vertigo as debris repositions itself immediately after the maneuver. Don't drive yourself home.

epley45.gif (6379 bytes)2. Sleep semi-recumbent for the next night. This means sleep with your head halfway between being flat and upright (a 45 degree angle). This is most easily done by using a recliner chair or by using pillows arranged on a couch (see figure 3). During the day, try to keep your head vertical. You must not go to the hairdresser or dentist. No exercise which requires head movement. When men shave under their chins, they should bend their bodies forward in order to keep their head vertical. If eye drops are required, try to put them in without tilting the head back. Shampoo only under the shower. Some authors suggest that no special sleeping positions are necessary (Cohen, 2004; Massoud and Ireland, 1996). We, as do others, think that there is some value (Cakir et al, 2006)

3. For at least one week, avoid provoking head positions that might bring BPPV on again.

Be careful to avoid head-extended position, in which you are lying on your back, especially with your head turned towards the affected side. This means be cautious at the beauty parlor, dentist's office, and while undergoing minor surgery. Try to stay as upright as possible. Exercises for low-back pain should be stopped for a week. No "sit-ups" should be done for at least one week and no "crawl" swimming. (Breast stroke is OK.) Also avoid far head-forward positions such as might occur in certain exercises (i.e. touching the toes). Do not start doing the Brandt-Daroff exercises immediately or 2 days after the Epley or Semont maneuver, unless specifically instructed otherwise by your health care provider.

4. At one week after treatment, put yourself in the position that usually makes you dizzy. Position yourself cautiously and under conditions in which you can't fall or hurt yourself. Let your health care provider know how you did.

Published literature referred to above:

Copyright August 3, 2016 , Timothy C. Hain, M.D. All rights reserved. Last saved on August 3, 2016