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Dizziness

Semont liberatory manourve for BPPV


Semont liberatory manoeuvre for Benign Paroxysmal Positioning Vertigo (BPPV)

The Semont manoeuvre is an alternative to the Epley manoeuvre to treat BPPV. The Epley is easier to perform, but the Semont can be used if you fail the Epley. The following diagrams and instructions relate to treatment of BPPV of the right or the left posterior semicircular canals of the inner ear. These canals are the ones most commonly affected by positioning vertigo.

If you are unsure which of your posterior canals is affected, do the first stage of the treatment to see which is the affected ear and continue with the side that makes you dizzy.

The diagrams show the manoeuvres you should use to remove particles from your semicircular canal that are responsible for your BPPV.  The manoeuvres produce dizziness as the particles move within the canal.  You may find the dizziness less troublesome if you perform this exercise with your eyes closed.  The manoeuvres should be performed daily until you are free of symptoms.   In an outpatient study we did with a single treatment in 18 affected patients 70% experienced complete relief of their dizziness and most within 7 to 10 days.  All patients noted a gradual improvement in their dizziness from the 1st or 2nd day.  There are occasional exceptions to this.  If the symptoms do persist, despite conscientious performance of the exercises, your condition should be reviewed.

In the following exercise it is important that stages 1 and 2 (shown in the pictures below) are performed as quickly as possible. An important aspect of treatment with the Semont manoeuvre is to turn your head 45° away from the direction in which you are to fall and for your head to be maintained in the same 45° angle throughout the whole manoeuvre. This is best done by having someone hold your head to maintain the 45° angle  throughout the positioning manoeuvre.

For symptoms related to the right ear follow the instructions below:
 

 

PSC_1.jpg

  1. Turn your head 45 degrees  to the Left.
  2. Fall down quickly onto your right shoulder (shown in the picture), still keeping your head at 45 degrees to the left.
  3. Wait 1 minute in this position. Do not move your head from the 45 degree position.
  4. Then in one quick and uninteruppted movement, keeping your head at the same 45 degrees, move all the way across onto your left shoulder.
  5. Again, wait 1 minute, without moving your head.
  6. With your head still at 45 degrees, swing yourself back to an upright position.


For the symptoms related to the left ear:
 

PSC_2.jpg

  1. Turn your head 45 degrees to the Right.
  2. Moving quickly to your left, perform Stage 1, then follow steps 3-6 outlined above.

 
If you feel dizzy at the end of both Stage 1 and Stage 3, be encouraged as you may have moved the material out of the canal.  These exercises should be done daily until the dizziness no longer occurs.  Stop the exercises as soon as you are free of vertigo.  There is a 40% chance of recurrence over 30 months.