Benign paroxysmal positional vertigo: The “Sémont PLUS maneuver” is more effective than the Sémont maneuver – a prospective multinational randomized single-blinded trial (2338)

Objective: To compare the efficacy of the Semont (“SM”) with the new “Semont PLUS maneuver” (“SM+”) in a prospective multinational randomized single-blinded trial in patients with posterior canal benign paroxysmal positional vertigo (pc-BPPV). Background: Although there is Class I evidence for the efficacy of the Semont and Epley maneuvers in pc-BPPV many patients suffer longer than necessary. Based on our biophysical model of BPPV we hypothesized that the “SM+” is more effective than the “SM” because this model showed that tilting of the affected canal towards the affected side moves the otoconia further towards the exit of the posterior canal. Design/Methods: In a prospective multinational (Germany, Italy, Belgium) randomized single-blinded treatment trial patients with proven posterior canal BPPV – according to the diagnostic criteria of the International Classification of Vestibular Disorders – were randomly assigned (1:1) to the “SM” or “SM+”. The latter is characterized by an overextension of the head/body by 45° below earth horizontal line during step 2 of the maneuver. The first three maneuvers were performed by the physician. The patients were then instructed on how to do the maneuvers which they should perform 3times in the morning, 3times at noon and 3times at night. Each morning after the first maneuver of each day the patient documents in a standardized evaluation sheet, whether vertigo occurred or not. The primary endpoint was: “How long (in days) does it take until no attacks can be induced “in the morning” by the maneuvers?” Results: In the 167 patients analysed it took 3.9 days (mean; range 1–33 days) for the “SM” and only 2.3 days (range 1–32 days) for the “SM+” for recovery (p=0.015, Mann-Whitney-u-test). Conclusions: This prospective multinational randomized trial showed that the “SemontPLUS maneuver” is significantly more effective than the Semont maneuver. It also confirms the hypothesis based on a biophysical model of BPPV. Disclosure: Dr. Strupp has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with MS has received speaker’s honoraria from Abbott, Actelion, Auris Medical, Biogen, Eisai, Grunenthal, GSK, Henning Pharma, Interacoustics, Merck, MSD, Otometrics, Pierre-Fabre, TEVA, UCB. He acts as a consultant for Abbott, Actelion, AurisMedical, Heel, In. Dr. Strupp has received personal compensation in an editorial capacity for MS is Joint Chief Editor of the Journal of Neurology, Editor in Chief of Frontiers of Neuro-otology and Section Editor of F1000.. Dr. Strupp has received research support from Decibel, J&J. Dr. Vinck has nothing to disclose. Dr. Bayer has nothing to disclose. Dr. Hennig has nothing to disclose. Dr. Obrist has nothing to disclose. Dr. Mandala has nothing to disclose.