Double-blind randomized trial on short-term efficacy of the Semont maneuver for the treatment of posterior canal benign paroxysmal positional vertigo.
The need for Class I and II studies on the efficacy of Semont's liberatory maneuver (SLM) in the treatment of posterior canal benign paroxysmal positional vertigo (PC-BPPV) motivated the present double-blind randomized trial on the short-term efficacy of SLM. A total of 342 patients with unilateral PC-BPPV were recruited for a multicenter study. Patients were randomly assigned to treatment by SLM (n = 174) or sham treatment (n = 168). Subjects were followed up twice (1 and 24 h) with the Dix-Hallpike maneuver by blinded examiners. At the 1 and 24 h follow-up, 79.3 and 86.8%, respectively, of patients undergoing SLM had recovered from vertigo, compared to none of the patients undergoing the sham maneuver (p < 0.0001). Patients who manifested liberatory nystagmus at the end of SLM showed a significantly higher percentage of recovery (87.1 vs. 55.7%; p < 0.0001). To the best of our knowledge, this is the first Class I study on the efficacy of SLM. SLM proved highly effective with respect to the sham maneuver (p < 0.0001). Liberatory nystagmus was demonstrated to be a useful prognostic factor for the efficacy of treatment. The present Class I study of efficacy of SLM changes the level of recommendation of the maneuver for treating PC-BPPV from level C to level B.
Dipartimento di Scienze Neurologiche e Sensoriali, Università di Siena, Siena Viale Bracci, 11, 53100, Siena, Italy. marcomand@hotmail.com
Marco
M
Mandalà
Giovanni Paolo
GP
Santoro
Giacinto
G
Asprella Libonati
Augusto Pietro
AP
Casani
Mario
M
Faralli
Beatrice
B
Giannoni
Mauro
M
Gufoni
Vincenzo
V
Marcelli
Pierpaolo
P
Marchetti
Emanuela
E
Pepponi
Paolo
P
Vannucchi
Daniele
D
Nuti
D000328:Adult; D000368:Aged; D065635:Benign Paroxysmal Positional Vertigo; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009759:Nystagmus, Pathologic / Q000209:etiology / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D016896:Treatment Outcome; D014717:Vertigo / Q000150:complications / Q000534:rehabilitation*