Is the Semont manoeuvre (Canalith Repositioning Maneuver, CRM) both a provoking manoeuvre and a treatment for Benign Paroxysmal Positional Vertigo (BPPV)?

The Semont Maneuver in BPPV: Both Diagnostic and Therapeutic Role

The Semont maneuver serves primarily as a treatment (canalith repositioning maneuver) for BPPV rather than as a diagnostic/provoking maneuver, though it can sometimes inadvertently provoke symptoms during its execution. 1

Primary Role: Treatment Maneuver

• The Semont maneuver (also called liberatory maneuver) is specifically designed as a canalith repositioning maneuver (CRM) to treat posterior canal BPPV by moving displaced otoconia from the semicircular canal back into the vestibule 1
• It involves a sequence of rapid head and body movements: starting with the patient seated upright, head turned 45° away from affected ear, then quickly moved to side-lying position on the affected side for 30 seconds, followed by rapid movement to the opposite side-lying position without changing head position relative to shoulder, and finally returning to upright position 1

Diagnostic/Provoking Maneuvers vs. Treatment Maneuvers

• The Dix-Hallpike test is the standard diagnostic/provoking maneuver for posterior canal BPPV, not the Semont maneuver 1, 2
• The supine roll test is the standard diagnostic/provoking maneuver for horizontal canal BPPV 1, 2
• While the Semont maneuver may provoke symptoms during its execution (as it moves the patient through positions that can displace otoconia), this is a side effect rather than its primary purpose 1

Efficacy as a Treatment

• The Semont maneuver has demonstrated effectiveness in treating posterior canal BPPV with resolution rates of:
  • 94.2% at 6-month follow-up in one study 1
  • 71% symptom resolution at 1 week in another study (comparable to Epley maneuver's 74%) 1
• However, the Epley maneuver (CRP) showed superior outcomes at 3-month follow-up compared to the Semont maneuver in one study 1

Clinical Application and Considerations

• The Semont maneuver is particularly useful for patients who have difficulty with neck extension required by the Epley maneuver 3, 4
• Self-administered modified Semont maneuver has shown 58% resolution of positional nystagmus at 1 week, though this is less effective than self-administered CRP (95%) 1
• The maneuver may cause transient provocation of BPPV symptoms, nausea, or sense of falling during execution 1, 2

Practical Implementation

• The Semont maneuver requires rapid, brisk movements which may be contraindicated in patients with vertebrobasilar insufficiency, cervical spondylosis, or back problems 4
• No postprocedural restrictions are recommended after performing the Semont maneuver 2
• Multiple treatments may be necessary if symptoms persist after initial maneuver 1, 2

Common Pitfalls and Caveats

• Canal conversion (changing from posterior to horizontal canal BPPV) can occur in about 6-7% of cases during treatment 1, 2
• Patients with physical limitations including cervical stenosis, severe rheumatoid arthritis, cervical radiculopathies, or spinal issues may not be candidates for this maneuver 1
• Failure to move the patient quickly enough during the maneuver may reduce its effectiveness 1