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Purpose <p>Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder, often affecting the posterior semicircular canal (PC). Treatment for PC-BPPV typically involves repositioning or liberatory maneuvers, such as the Epley and Semont maneuvers. A rare but concerning event may occur at the end of these maneuvers: the patient may experience an intense sensation of falling with pronounced retropulsion, resembling a “Tumarkin-like” crisis. This phenomenon is entirely distinct from the so-called “residual dizziness,” a long-lasting, chronic condition unrelated to the acute postural crisis and characterized by persistent postural imbalance following resolution of the acute phase. In 2023, Shigeno introduced a modification of the Epley maneuver to prevent such episodes. This study aimed to assess the efficacy of the Shigeno correction when applied to both the Epley and Semont maneuvers in a cohort of PC-BPPV patients.</p> Methods <p>We evaluated 200 patients diagnosed with PC-BPPV between July 2024 and June 2025. Patients were randomly assigned to two equal groups: one group of 100 received the Semont maneuver, and the other 100 underwent the Epley maneuver. In each group, 50 patients received the standard maneuver, and 50 received the maneuver with the Shigeno correction. Patients were reassessed one hour after the procedure and again one week later.</p> Results <p>Our findings revealed a significant correlation between the use of the Shigeno correction and a reduction in postural crises in both the Epley and Semont maneuvers. In the group receiving the traditional maneuvers, 12 patients experienced postural crises, while none in the corrected maneuver groups reported such events.</p> Conclusion <p>Incorporating the Shigeno correction into both the Epley and Semont maneuvers is highly recommended in the management of PC-BPPV. This simple modification effectively reduces the incidence of severe postural crises, which pose significant risks, particularly for elderly or comorbid patients. Performing these maneuvers under the supervision of a trained healthcare professional minimizes associated risks and enhances therapeutic outcomes.</p> Terminology <p><b>• Upbeating nystagmus:</b> a nystagmus in which the fast phase beats toward the patient’s forehead.</p> <p><b>• Downbeating nystagmus:</b> a nystagmus in which the fast phase beats toward the patient’s chin.</p>

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Shigeno correction technique is effective in reducing postural crises in the treatment of posterior canal benign paroxysmal positional vertigo

  • 期刊论文

  • 发表日期：

    2025年12月13日

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  • Luigi Califano,
  • Gorkem Ertugrul,
  • Giuseppe Santopietro,
  • Maria Grazia Melillo,
  • Daniele Nuti,
  • Salvatore Martellucci

摘要

Purpose

Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder, often affecting the posterior semicircular canal (PC). Treatment for PC-BPPV typically involves repositioning or liberatory maneuvers, such as the Epley and Semont maneuvers. A rare but concerning event may occur at the end of these maneuvers: the patient may experience an intense sensation of falling with pronounced retropulsion, resembling a “Tumarkin-like” crisis. This phenomenon is entirely distinct from the so-called “residual dizziness,” a long-lasting, chronic condition unrelated to the acute postural crisis and characterized by persistent postural imbalance following resolution of the acute phase. In 2023, Shigeno introduced a modification of the Epley maneuver to prevent such episodes. This study aimed to assess the efficacy of the Shigeno correction when applied to both the Epley and Semont maneuvers in a cohort of PC-BPPV patients.

Methods

We evaluated 200 patients diagnosed with PC-BPPV between July 2024 and June 2025. Patients were randomly assigned to two equal groups: one group of 100 received the Semont maneuver, and the other 100 underwent the Epley maneuver. In each group, 50 patients received the standard maneuver, and 50 received the maneuver with the Shigeno correction. Patients were reassessed one hour after the procedure and again one week later.

Results

Our findings revealed a significant correlation between the use of the Shigeno correction and a reduction in postural crises in both the Epley and Semont maneuvers. In the group receiving the traditional maneuvers, 12 patients experienced postural crises, while none in the corrected maneuver groups reported such events.

Conclusion

Incorporating the Shigeno correction into both the Epley and Semont maneuvers is highly recommended in the management of PC-BPPV. This simple modification effectively reduces the incidence of severe postural crises, which pose significant risks, particularly for elderly or comorbid patients. Performing these maneuvers under the supervision of a trained healthcare professional minimizes associated risks and enhances therapeutic outcomes.

Terminology

• Upbeating nystagmus: a nystagmus in which the fast phase beats toward the patient’s forehead.

• Downbeating nystagmus: a nystagmus in which the fast phase beats toward the patient’s chin.