Treatment of apogeotropic benign positional vertigo: comparison of therapeutic head-shaking and modified Semont maneuver

• DOI: 10.1007/s00415-009-5122-6
• Publication Date: 2009-04-10T22:39:11Z
• Authors: S.-Y. Oh; Ji-Soo Kim; S.-H. Jeong; Y.-M. Oh; K.-D. Choi; B.-K. Kim; S.-H. Lee; H.-S. Lee; I.-S. Moon; J.-J. Lee
• Keywords: Adult; Male; Posture; Middle Aged; Vibration; Mastoid; Nystagmus, Pathologic; Semicircular Canals; Exercise Therapy; 3. Good health; Young Adult; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Head Movements; Vertigo; Humans; Female; Prospective Studies; Vestibule, Labyrinth; Physical Therapy Modalities; Aged

Several methods of physiotherapy have been advanced for apogeotropic type benign positional vertigo involving the horizontal semicircular canal (HC-BPV). The aim of this study was to determine the therapeutic efficacies of the proposed maneuvers in apogeotropic HC-BPV. Using a prospective randomized trial involving seven nationwide dizziness clinics in Korea, we compared the immediate efficacies of head-shaking and modified Semont maneuvers in 103 consecutive patients with apogeotropic HC-BPV. We also determined an additional therapeutic benefit of mastoid oscillation while the patients without response to both maneuvers were performing the Brandt-Daroff exercise. Successful treatment was defined as resolution of positional vertigo and nystagmus, or as transition into geotropic HC-BPV. Results showed that head shaking was more effective than the modified Semont maneuver (37.3 vs. 17.3%, P = 0.02). However, therapeutic efficacy did not differ between the maneuvers after the initial non-responders switched over to the other maneuver (23.3 vs. 25.0%, P = 0.861). Mastoid oscillation provided no additional benefit while the patients without response to both maneuvers were performing the Brandt-Daroff exercise. Most positional vertigos resolved within a week (89.4%) irrespective of the treatment modalities applied and all showed resolution within 28 days. The head-shaking maneuver described here proved more effective than the modified Semont maneuver in treating apogeotropic HC-BPV. Mastoid vibration conferred no additional benefit during the Brandt-Daroff exercise.