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Vertigo: Semont Maneuver for PPPV Balance Disorders

  • Date: 2009/07/07 (Rev. 2015/07/30)
  • Disabled World - Disabled World
  • Synopsis : Video showing the Semont maneuver effective in ridding the symptoms of benign paroxysmal positional vertigo.

Main Document

The diagnosis of BPPV is made by the characteristic symptoms and also by observing the nystagmus - the jerking of the eyes that accompanies the severe vertigo patients experience when the position of their head is changed. By tilting a patients head way back at the end of an examining table, a doctor will try to provoke the symptoms to see the nystagmus for a thorough diagnosis.

Benign paroxysmal positional vertigo (BPPV) is one of the most frequent causes of vertigo. Vertigo is defined as a condition where a person feels like they are moving when they are not. Often it feels like a spinning or swaying movement. There may be associated nausea, vomiting, sweating, or difficulties walking. BPPV is characterized by a peripheral balance impairment which occurs during specific movements or positions of the head. BPPV occurs when small, micro-sized calcium crystals called otoconia become dislodged from their normal location on the utricle, one of the inner ear sensory organs. These otoconia are usually embedded in a gelatin like material on top of the utricle. If the otoconia become detached, they are free to flow in the fluid filled spaces of the inner ear, including the semicircular canals which sense the rotation of the head.

BPPV may be made worse by any number of modifiers which may vary between individuals:

  • Stress
  • Lack of sleep (required amounts of sleep may vary widely)
  • Changes in barometric pressure - patients often feel symptoms approximately two days before rain or snow
  • BPPV may also be triggered by dehydration, such as that caused by diarrhea. For this reason, it commonly occurs in post-operative patients who have diarrhea caused by post-operative antibiotics.

The Semont maneuver

This involves the patient rapidly moved from lying on one side to lying on the other. A single 10 to 15 minute session is usually all that is required.

The Semont maneuver (also called the "liberatory" maneuver) is effective in ridding the symptoms of benign paroxysmal positional vertigo (BPPV) with a cure rate of 90.3%.

When your head is firmly moved into the different positions, the crystal debris, or canaliths, causing vertigo will move freely and no longer cause the BPPV symptoms.

The Semont and modified Epley maneuvers are more effective than other treatments for BPPV, such as the Brandt-Daroff exercise.

The Semont maneuver is done with the help of a doctor or physical therapist.

A single 10 to 15 minute session usually is all that is needed.

When your head is firmly moved into different positions, the crystal debris (canaliths) causing vertigo moves freely and no longer causes symptoms.

The Semont maneuver is performed as follows:

  • When seated the doctor turns your head 45 degrees horizontally toward the unaffected ear.
  • The doctor then tilts you 105 degrees so that you are lying on the side of the affected ear with your head hanging and your nose pointed upward. You remain in this position for around 3 minutes - allowing debris to move to the apex of the ear canal.
  • The doctor then moves you quickly from the seated position, holding your head in place, until you are lying on the side of the unaffected ear with your nose pointed to the ground. You remain in this position for 3 minutes allowing the debris to move toward the exit of the ear canal.
  • The doctor then slowly moves you back to the seated position. The debris should fall into the utricle of the canal, where it will no longer cause vertigo sensations.

The Semont and Epley maneuvers may improve or cure benign paroxysmal positional vertigo (BPPV) with only one treatment, however some people may need multiple treatments.

There are various procedures and several different types of vertigo.

It is suggested that you start with a full Vestibular Evaluation by a Trained Vestibular MD or Therapist (Physical or Occupational) as they can assist in diagnosing your vertigo problem and then treat it appropriately.

Medical treatment with anti-vertigo medications may be considered in acute, severe exacerbation of BPPV, but in most cases are not indicated. These primarily include drugs of the anti-histamine and anti-cholinergic class, such as meclizine and scopolamine respectively.


Vertigo, a distinct process sometimes confused with the broader term, dizziness, accounts for about six million clinic visits in the United States every year; between 17 and 42% of these patients eventually are diagnosed with BPPV.

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