THE COMPARİSON OF THE SEMONT AND EPLEY MANEUVERS USED IN THE TREATMENT OF BPPV
Selçuk Üniversitesi Meram Tıp Fakültesi, Kulak Burun Boğaz ve Baş Boyun Cerrahisi Anabilim Dalı., Konya, Türkiye Objective: To evaluate the response of the patients and the results of the treatment of Semont and Epley maneuvers used in benign paroxysmal positional vertigo (BPPV).Materials and Methods: This prospective study includes 58 cases who had been diagnosed and treated as BPPV at Department of Otolaryngology, Meram Medical School, University of Selcuk, between January 2001 and May 2003. The diagnosis of BPPV was made on the basis of patient history and a positive response to the Dix-Hallpike maneuver. Ten minutes later, Semont maneuver was applied to 29 patients, and the other 29 were treated with Epley maneuver. The patients were controlled the next day, 1 week and 1 month following the treatment. Both applications were compared in regard to the patients complaints and Dix-Hallpike maneuver.
Results: The mean age of 58 patients was 52,58+14,3 (22-79) 38 (65.5%) of them were female and 20(34.5) were male. The right ear was involved in 29 patients (50%) and the left ear in 23 (40%). BPPV was bilateral in six patients (10%). The therapeutic maneuver was performed for 64 ears. The mean duration of the symptoms was about 11.9 months.
During the first visit following treatment, a complete recovery was observed in 21 (65.6%) ears out of 32 in which the Semont maneuver was performed. The same maneuver was applied to 11 patients having torsional nystagmus and vertigo when Dix-Hallpike maneuver was applied. The second maneuver was successful in seven cases. The success rate was 87.5% with two applications. Four (12.5%) patients were still suffering from positional vertigo one month following the two treatments.
Epley maneuver was applied in 32 ears. Twenty-six (81.25%) ears were recovered completely with the first application. At the end of the first week, Epley maneuver was repeated in 6 ears. The symptoms were mostly diminished in 4 of the ears. The success rate was 93.75% following second maneuver. Two patients (6.25%) still had symptoms at the end of the first month. Comparison of both maneuvers Epley and Semont showed no significant differences in regard to results of treatment.
Conclusion: In the patients with only positional vertigo without any additional neurological and vestibular symptoms, the consideration of the use of the treatment maneuvers may be helpful to reduce the cost effects and the time consumption. It is difficult to compare the treatment methods properly as BPPV is paroxysmal and it represents spontaneous remission lasting weeks to months. Considering the physical status, we suggest that Epley maneuver is more convenient for the patients who are old, fat and having vertebra disorders.
Keywords : BPPV, Semont/Epley maneuver, treatment