Epley maneuver for vertigo pdf2/14/2024 ![]() It should thus increase the effectivity of the maneuver. This also predicts that more otoconia should then move beyond the vertex of the canal when the patient is subsequently moved toward the unaffected side ( Figure 1, Supplementary Video 1). The Sémont maneuver (SM) was published in 1988 ( 7), and the Epley maneuver in 1992 ( 8) both are effective ( 9– 11).īased on our biophysical model of BPPV ( 12), we hypothesized that the new “SémontPLUS maneuver” (SM+) is more effective than SM because this model shows that the more the affected canal is tilted toward the affected side during the movement of the head toward the affected side, the further the otoconia move toward the exit of the posterior canal ( 13). The treatment of choice is liberatory or repositioning maneuvers to remove the otoconia from the affected canal ( 6). ![]() In about 85-95% of patients, the posterior canal is affected with a canalolithiasis (can) as the underlying pathomechanism ( 4, 5). It also supports the hypothesis of the biophysical model: overextension of the head during step 2 brings the clot of otoconia beyond the vertex of the canal, which increases the effectivity.Ĭlassification of Evidence: This study provides Class I evidence that SM+ is superior to SM for multiple treatment maneuvers of pcBPPVcan.īenign paroxysmal positional vertigo (BPPV) is a very frequent cause of vertigo, with a reported prevalence of 10-140 per 100,000 and a lifetime prevalence of 2.4% ( 1, 2). Interpretation: This prospective trial shows that SM+ is more effective than SM when repeated therapeutic maneuvers are performed but not when a single maneuver is performed. There was no difference in the second primary endpoint (chi 2-test, p = 0.39). Results: In the 194 patients analyzed (96 SM, 98 SM+), it took 2 days (median, range 1–21 days, mean 3.6 days) for recovery with SM and 1 day (median, range 1-8 days, mean 1.8 days) with SM+ ( p = 0.001, Mann-Whitney U-test). The primary endpoints were: “How long (in days) does it take until no attacks can be induced?” and “What is the efficacy of a single SM/SM+?” ![]() Each morning the patient documented whether vertigo could be induced. The first maneuver was done by the physician, and the subsequent maneuvers by the patients 9 times/day on their own. Methods and Patients: In a prospective trinational (Germany, Italy, and Belgium) randomized trial, patients with pcBPPVcan were randomly assigned to SM or SM+ SM+ means overextension of the head by 60+° below earth horizontal line during the movement of the patient toward the affected side. Objective: To compare the efficacy of the Sémont maneuver (SM) with the new “SémontPLUS maneuver” (SM+) in patients with posterior canal BPPV canalolithiasis (pcBPPVcan). 5ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.4Department of Otolaryngology, University of Siena, Siena, Italy. ![]() ![]() 2Department of Otolaryngology, Algemeen Ziekenhuis Brugge, Brugge, Belgium.1Department of Neurology, German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany.Michael Strupp 1 * † Nicolina Goldschagg 1 † Anne-Sophie Vinck 2 Otmar Bayer 1,3 Sebastian Vandenbroeck 2 Lorenzo Salerni 4 Anita Hennig 1 Dominik Obrist 5 Marco Mandalà 4 ![]()
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