To compare the efficacy of the new SemontPLUS maneuver (SM+) with the Epley maneuver (EM) in patients with posterior canal benign paroxysmal positional vertigo (pc-BPPV canalithiasis).

In a previous study we demonstrated that the SM+ is superior to the regular SM. Since other studies showed that the regular SM and the Epley maneuver (EM) are equally effective, we hypothezised that the SM+ is more effective than the EM for the treatment of the posterior canal BPPV canalithiasis. 

In a prospective multinational (Germany, Italy, Belgium) randomized treatment trial, patients with proven posterior canal BPPV canalithiasis – according to the diagnostic criteria of the International Classification of Vestibular Disorders – were randomly assigned (1:1) to  “SM+” or EM. The SM+ is characterized by an overextension of the head/body by at least 60° 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 self-maneuvers which they perform three times in the morning, three times at noon and three times at night.  Each morning after the first maneuver of each day the patient documented in a standardized evaluation sheet whether vertigo occurred. The primary endpoint was: “How long (in days) does it take until no attacks can be induced “in the morning” by the maneuvers?”

195 patients were finally analyzed. For the EM it took a mean of 3.34 days (SD 3.6) and a median 1 day for recovery. F or the SM+ it took a mean of 1.96 days (SD 1.6) and a median 1 day for recovery. Statistical analysis with the two-sided Mann-Whitney-u-test revealed a P value of 0.012.

This prospective tri-national randomized trial shows that the SM+ maneuver is superior to the EM in terms of the time it takes until recovery.