Self-treatment of benign paroxysmal positional vertigo: Semont maneuver vs Epley procedure

To the Editor:

I read with interest the editorial by Furman and Hain¹ concerning the home treatment of benign paroxysmal positional vertigo (BPPV). This is also reported by Radtke et al.^2,3 The first two treatments were designed when the understanding of the mechanism of the disease was erroneous. The condition was known as cupulolithiasis, believed to result from adventitious deposits in the cupula of the posterior semicircular canal (PSC) changing the organ into a gravity sensor.

Following the observations of Parnes,⁴ it was accepted that the pathology of BPPV consisted of the presence in the fluid of the PSC of aggregated otoconia detached from the vestibular maculae, changing the hydrodynamics of the endolymphatic fluid inside the canal. The result is an abnormal function of the crista sensory organ, albeit with different characteristics than the predicted by cupulolithiasis, and more consistent with clinical observations whereby vertigo is produced by quick head rotations only in the plane of the affected PSC, a key in the diagnosis of the condition.

Epley's article,⁵ concerning the canalith repositioning procedure as a treatment for BPPV, provided strong evidence that particles could be extracted from the canal by rotating the patient's head in the geometrical plane of the canal, facilitating the particle's excursion towards the vestibule as propelled by the force of the gravitational vector upon the slug of heavier particles if executed within an appropriate time course. The success of the …