Epley and Semont Maneuvers for Vertigo

Treatment Overview

The Epley and Semont maneuvers are exercises used to treat benign paroxysmal positional vertigo (BPPV). They are done with the help of a doctor or physical therapist. A single 10- to 15-minute session usually is all that's needed.

When your head is firmly moved into different positions, the calcium crystal (canalith) debris that causes vertigo also moves. The debris will slip out of the semicircular canal into an area of the inner ear where it will no longer cause symptoms. Two maneuvers have been used successfully: the Epley maneuver and the Semont maneuver.

In some cases, your doctor or physical therapist may have you do a modified Epley procedure at home. If your doctor has shown you how and you feel confident, you can try this at home to get rid of your vertigo.

How It Is Done

Epley maneuver

This maneuver is done with the assistance of a doctor or physical therapist. A single 10- to 15-minute session usually is all that is needed. When your head is firmly moved into different positions, the crystal debris (canaliths) causing vertigo will move freely and no longer cause symptoms.

Epley maneuver: Step 1

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You will sit on the doctor's exam table with your legs extended in front of you. The doctor will turn your head so that it is halfway between looking straight ahead and looking directly to the side that causes the worst vertigo. Without changing your head position, the doctor will guide you back quickly so that your shoulders are on the table but your head is hanging over the edge of the table. In this position, the side of your head that is causing the worst vertigo is facing the floor. The doctor will hold you in this position for 30 seconds or until your vertigo stops.

Epley maneuver: Step 2

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Then, without lifting up your head, the doctor will turn your head to look at the same angle to the opposite side, so that the other side of your head is now facing the floor. The doctor will hold you in this position for 30 seconds or until your vertigo stops.

Epley maneuver: Step 3

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The doctor will help you roll in the same direction you are facing so that you are now lying on your side. (For example, if you are looking to your right, you will roll onto your right side.) The side that causes the worst vertigo should be facing up. The doctor will hold you in this position for another 30 seconds or until your vertigo stops.

Epley maneuver: Step 4

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The doctor will then help you to sit back up with your legs hanging off the table on the same side that you were facing.

Semont maneuver

The Semont maneuver is done with the help of a doctor or physical therapist. A single 10- to 15-minute session usually is all that is needed. When your head is firmly moved into different positions, the crystal debris (canaliths) causing vertigo moves freely and no longer causes symptoms.

• First, you sit on the exam table with your legs hanging off the edge.
• The doctor turns your head so that it is halfway between looking straight ahead and looking away from the side that causes the worst vertigo.
• The doctor then lowers you quickly to the side that causes the worst vertigo. When your head is on the table, you are looking up at the ceiling. The doctor holds you in this position for 30 seconds.
• The doctor then quickly moves you to the other side of the table, without stopping in the upright position. When your head is on the table, you are now looking down at the table. The doctor holds you in this position for 30 seconds.
• The doctor then helps you sit back up.

What To Expect

The Epley and Semont maneuvers may improve or cure benign paroxysmal positional vertigo (BPPV) with only one treatment. Some people need multiple treatments.

Why It Is Done

Epley and Semont maneuvers are used to treat benign paroxysmal positional vertigo (BPPV).

How Well It Works

The Epley procedure is safe and works well to treat benign paroxysmal positional vertigo (BPPV).^{footnote 1}

The Semont maneuver may work to stop symptoms of BPPV. But the evidence is not as good as it is for the Epley procedure.^{footnote 1}

Risks

These maneuvers should not be done on people with back or spine injuries or problems.

Sometimes the maneuver can move the debris from one inner ear canal to another. This can cause a different kind of vertigo.