Assessment for benign paroxysmal positional vertigo in medical patients admitted with falls in a district general hospital

Abstract

Having benign paroxysmal positional vertigo (BPPV) puts patients at a signifi cantly higher risk of falling. It is poorly recognised and diagnosis is frequently delayed. BPPV has been studied in outpatient settings, but there have been no studies looking at the prevalence in patients admitted with falls. This study aims to establish how common BPPV is in these patients. For a 4-month period, patients admitted on an unselected medical take were screened for an admission precipitated by a fall. Patients who consented were assessed for BPPV using the Dix-Hallpike manoeuvre. Patients who tested positive were treated using the Epley manoeuvre. The assessments were carried out by specialist physiotherapists who were experienced at assessing and diagnosing patients with peripheral vestibular disorders. Out of the 111 patients initially identifi ed, 37 (33%) were considered to be appropriate and consented to be part of the study. Of these, 20 patients (54%) had a positive Dix-Hallpike manoeuvre. Of the patients included in the study, over half tested positive for BPPV. This merits further study. Potentially, there is a proportion of patients admitted with falls who have an easily treatable contributing factor that is not being identifi ed with standard practice.

Neuro-otology- some recent clinical advances

“…The vertigo attacks are brief, usually lasting seconds, rarely minutes, triggered by bending down, looking up or rolling over in bed [3]. The elderly might present with falls getting out of bed [4]. BPV is caused by otoconia dislodged from an otolith macula, moving within a semicircular canal duct (“canalithiasis”) [5] or becoming attached to its cupula (“cupulolithiasis”).…”

Risk Factors for Positional Vertigo and the Impact of Vertigo on Daily Life: The Korean National Health and Nutrition Examination Survey

“…PV is associated with a risk of falls and limitations of activity, especially in the elderly [2,14,28,29]. Abbott, et al [29] reported that about half of all patients who fall had PV. We found that the fall risk increased significantly in those with PV.…”

Comparative evaluation of the diagnostic value of the VHIT and Dix-Hallpike test in patients with balance system disorders in out-patient healthcare practice and expertise preparation

“…This was followed by performance of the Dix-Hallpike original article dIscussIon Dizziness, especially BPPV, is often misdiagnosed by inexperienced doctors, and as such, is diagnosed late. Abbott et al [11] indicate that the average time between the onset of symptoms and the definitive diagnosis was 70 months and about eight hospitalizations of the patient. Vigilance and appropriate knowledge allow for the patient's early referral to a specialist, basic tests and implementation of appropriate treatment, which is important in outpatient practice and medical jurisdiction.…”