Treatment:  

1:  Begin with the patient positioned sitting at the edge of the table.  Have the patient rotate their head 45 degrees away from the affected ear
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2:  Support the patient's head, and quickly move the patient into side lying towards the affected side.  Their head should be facing away from the table.  It is helpful to use two hands on the patient's head, supporting the front of their head with the webbed space of your hand.  Patient remains in this position for 2 to 3 minutes (Herdman, S. J. 2007).

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-Typically, vertigo reappears in this position.  If patient does not experience vertigo, abruptly shake head once or twice (Herdman, S. J. 2007.


3:  Hold the patient's head, keeping it in the same position (facing away from the table).  Quickly, move the patient into the opposite side-lying position, and abruptly stop the patient's movement when their head nears the table.  The head position should not change from the initial 45 degree rotation performed in step 1.  The patient's head should be facing down towards the table.  Remain in this position for 1-2 minutes.



 

-Following liberatory maneuver, re-assess for remaining debris with hallpike test.  Often times, conversion from cupulolithiasis to canalolithiasis occurs, and technique should be followed by the epley maneuver (opinion).



Timing

Herdmen S. J., 2007 states that it is not clear why the original procedure calls for patient's to be in each position for extended periods of time (facing upward 2-3 minutes, facing downward 5 minutes).  The author recommends maintaining each position for 1 minute.  



Evidence



Evidence is limited.  "Semont maneuver is more effective than no treatment or Brandt-Daroff exercises in relieving posterior canal BPPV (Bhattacharyya et al., 2008)."