Semont and Epley Maneuvers

Until 1980, treatment of benign paroxysmal positional vertigo (BPPV) mainly consisted of reassuring patients of the benign nature of the condition and a recommendation that they avoid the critical position changes that induced the vertigo. Most patients had a spontaneous remission, although not infrequently the condition recurred. The same benign course was seen whether BPPV occurred after head trauma or an ear infection or if it occurred spontaneously. Although brain lesions could produce positional vertigo and nystagmus, the stereotyped torsional vertical nystagmus of BPPV was a reliable signature of a benign inner ear disorder. In the 1980s, Alan Semont, a physical therapist in Paris, and John Epley, an otolaryngologist in Oregon, proposed the first treatment maneuvers specifically designed to remove otoconial debris from the posterior semicircular canal and cupula. Although initially there was skepticism regarding the efficacy of these maneuvers, they have been proven effective in multiple controlled treatment trials.