Effectiveness of Dias Repositioning Maneuver Versus Semont Maneuver in Patients With Benign Paroxsymal Positional Vertigo (Pc-bppv): A Comparative Study

Technical Summary: Effectiveness of Dias Repositioning Maneuver Versus Semont Maneuver in PC-BPPV

Problem Statement
Benign Paroxysmal Positional Vertigo (BPPV) is the most prevalent vestibular disorder, characterized by transient vertigo triggered by head position changes due to displaced otoconia migrating into the semicircular canals, most commonly the posterior canal (PC-BPPV). While canalith repositioning maneuvers are the standard first-line therapy, the Semont Maneuver, a widely used liberatory treatment, requires rapid, abrupt lateral movements. These movements can induce anxiety, nausea, cervical pain, and poor tolerance, particularly in older adults or patients with musculoskeletal limitations. The Dias Repositioning Maneuver has been introduced as a more progressive, controlled alternative involving supine-seated sequences. However, clinical research comparing the efficacy of this newer Dias technique against the established Semont Maneuver for PC-BPPV remains scarce. This study addresses the need to evaluate and compare the efficacy of these two specific interventions.

Methodology
This comparative study was conducted at a Vertigo Clinic in Vadodara over 11 months with ethical approval (CTRI/2024/08/072031). A sample of 30 patients diagnosed with PC-BPPV (confirmed via positive Dix-Hallpike test) was allocated equally into two groups using convenience sampling. Inclusion criteria included patients aged 21–60 of both genders; exclusion criteria covered bilateral BPPV, non-posterior canal involvement, other vestibular or central disorders, severe cardiovascular conditions, and cervical instability.

• Group A (Dias Maneuver, n=15): Participants underwent a single session of the Dias Repositioning Maneuver. The protocol involved supine positioning with chest elevation, neck extension (20°) and rotation (45°) toward the affected side for 1 minute post-nystagmus cessation. This was followed by a 135° head rotation toward the opposite side for 2 minutes, concluding with a seated position while maintaining head tilt and rotation.
• Group B (Semont Maneuver, n=15): Participants underwent a single session of the Semont Maneuver. This involved rapid lateral movements: rotating the head 45° toward the unaffected side, quickly moving to the affected side-lying position (held for 30 seconds or until nystagmus stopped), immediately shifting to the opposite side-lying position without changing head orientation (held for 30 seconds), and returning to sitting.

Outcome Measures
Data were collected at three time points: baseline (pre-intervention), 1-hour post-intervention, and 1-week post-intervention. The primary outcome measures were:

1. Vertigo Symptom Scale – Short Form (VSS-SF): To assess vertigo severity.
2. Dizziness Handicap Inventory (DHI): To assess dizziness-related functional disability.

Statistical analysis was performed using SPSS version 23, utilizing paired t-tests for within-group comparisons and independent t-tests for between-group comparisons, with significance set at p < 0.05.

Key Results

• Within-Group Improvements: Both groups demonstrated statistically significant improvements (p < 0.05) in both VSS-SF and DHI scores from baseline to 1-hour post-intervention, and from 1-hour to 1-week follow-up. This indicates that both maneuvers effectively reduced vertigo symptoms and disability.
• Immediate Post-Intervention (1-hour):
  • VSS-SF: Group A (Dias) showed a mean score of 2.80, while Group B (Semont) showed 5.47. The difference was statistically significant (p < 0.05), favoring the Dias maneuver for immediate symptom relief.
  • DHI: No statistically significant difference was found between the groups immediately post-intervention.
• One-Week Follow-Up:
  • VSS-SF: Both groups achieved low scores (Group A: 0.60; Group B: 0.73), with no significant difference between them, suggesting similar long-term efficacy in symptom reduction.
  • DHI: Group A (Dias) achieved a mean score of 2.53, significantly lower than Group B (Semont) at 6.27 (p < 0.05). This indicates that the Dias maneuver resulted in superior reduction of dizziness-related disability at the one-week mark.

Key Contributions and Claims
The study contributes to the literature by providing direct comparative data between the Dias and Semont maneuvers, a gap previously noted in clinical research. The authors claim that while both maneuvers are effective treatments for PC-BPPV, the Dias Repositioning Maneuver yields relatively superior results, particularly in the reduction of vertigo symptoms immediately post-treatment and in reducing disability ratings at the one-week follow-up.

Significance
The authors posit that the Dias maneuver may be regarded as an effective choice in clinical practice, potentially offering advantages over the Semont maneuver due to its progressive and controlled nature, which may enhance patient comfort and tolerance. The study suggests that the Dias maneuver could be a preferred alternative, especially for patients who may struggle with the rapid, abrupt movements required by the Semont technique. However, the authors modestly acknowledge limitations, including the small sample size (n=30), the use of convenience sampling, a single-center design, and a short follow-up period, noting that long-term recurrence rates were not assessed.