Tools · Manoeuvres · Therapeutic
TherapeuticPosterior canal

Semont liberatory manoeuvre

Alternative therapeutic manoeuvre for posterior canal BPPV. Uses rapid lateral position changes rather than head rotation. Similar efficacy to Epley in network meta-analysis.

Indication

Posterior canal BPPV — particularly useful when cervical extension is limited or painful, since the Semont avoids the head-hanging position required by the Epley.

Procedure

Step 1 of 4

Sit on the edge of the couch, head rotated 45° to unaffected side

Patient sits on the edge of the couch facing forward. Turn the head 45° toward the UNAFFECTED side (note: opposite to Epley start). Maintain this head rotation throughout the procedure.

Expected finding

Successful liberation resolves the patient's symptoms. As with the Epley, brief residual symptoms over 24–48 hours are normal.

After-care

Per the 2017 AAO guideline, no post-procedure restrictions are recommended.

Cautions

  • The swing-through is brisk — patient should be warned and pre-positioned safely.
  • Cervical pain that limits sustained head rotation — counselling and careful technique required.
  • Frail or unsteady patients — perform with an assistant or skip in favour of the Epley.

References

  • Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T, et al. (2017). Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngology — Head and Neck Surgery, 156(3 Suppl):S1–S47. link