Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) Executive Summary

Bhattacharyya, Neil; Gubbels, Samuel P.; Schwartz, Seth; Edlow, Jonathan A.; El-Kashlan, Hussam K.; Fife, Terry D.; Holmberg, Janene M; Mahoney, Kathryn; Hollingsworth, Deena B; Roberts, Richard A.; Seidman, Michael D.; Steiner, Robert W.; Tsai, Betty S.; Voelker, Courtney C. J.; Waguespack, Richard W.; Corrigan, Maureen D.

doi:10.1177/0194599816689660

Cited by 75 publications

(75 citation statements)

References 20 publications

(40 reference statements)

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“…This is of relevance both to vascular neurologists and to gerontologists, because a considerable percentage of dizzy patients with mild SVD are more likely to suffer from an undiagnosed peripheral vestibular disorder. These kinds of pathologies are usually treatable either by therapeutic maneuvers (BPPV) (19) or by vestibular rehabilitation programs (uncompensated vestibular loss) (20); this would help also in reducing the risk of falls and depression.…”

Section: Discussionmentioning

confidence: 99%

Aging with Cerebral Small Vessel Disease and Dizziness: The Importance of Undiagnosed Peripheral Vestibular Disorders

et al. 2017

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Recent studies showed a link between cerebral small vessel white matter disease (SVD) and dizziness: patients whose dizziness cannot be explained by vestibular disease show severe SVD and gait abnormalities; however, little is still known about how SVD can cause this symptom. The primary aim of this study is to examine the possible underlying causes of dizziness in neurovascular patients; this is in order to assess whether treatable causes could be routinely disregarded. A secondary aim is to possibly define a central oculomotor pattern induced per se by SVD. This could help the diagnosis of SVD-related dizziness. In this single-blind prospective study, 60 patients referred to a neurovascular clinic because of dizziness and SVD on imaging were divided into an L-SVD and a H-SVD group (low and high SVD burden, respectively), and then blindly examined with vestibulometric tests. In H-SVD group, the percentage of unexplained dizziness reached 82.8%. There was a higher prevalence of peripheral vestibular abnormalities in the L-SVD patient group (51.6%) than in the H-SVD (17.2%; p = 0.012). We found no differences in central oculomotor findings between the two groups. Although oculomotricity does not show any consistent pattern, a severe SVD can directly represent a cause of dizziness. However, a patient with mild SVD is more likely to suffer by a peripheral vestibular disorder. Therefore, given the high incidence of vestibular disease in neurovascular or geriatric clinics, clinicians should be cautious when ascribing dizziness solely to the presence of SVD as easily treatable peripheral vestibular causes may be missed.

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Section: Discussionmentioning

confidence: 99%

Aging with Cerebral Small Vessel Disease and Dizziness: The Importance of Undiagnosed Peripheral Vestibular Disorders

et al. 2017

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“…Variation in clinical care is one of the biggest obstacles facing health care organizations that prevents them from improving outcomes. 1 In previous work, Cramer et al 2 validated 5 quality metrics for head and neck cancer that meet validity criteria. High adherence to these metrics was associated with a 19% NHS CRD, National Health Service Centre for Reviews and Dissemination; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analyses; STREGA, Strengthening the Reporting of Genetic Association Studies.…”

Section: Variation In the Quality Of Head And Neck Cancer Care In Thementioning

confidence: 99%

“…Systematic reviews are the highest level of evidence in otolaryngology clinical practice guidelines. 1 However, they generally present only formally published data, which may lead to an inherent problem caused by publication bias, that is, a strong bias to publish only studies that show significant results. 2,3 This bias can be mitigated through both the search methods selected and the statistical methods used.…”

mentioning

confidence: 99%

Assessment of Publication Bias and Systematic Review Findings in Top-Ranked Otolaryngology Journals

Ross

Cooper

Gray

et al. 2019

JAMA Otolaryngol Head Neck Surg

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Systematic reviews are the highest level of evidence in otolaryngology clinical practice guidelines. 1 However, they generally present only formally published data, which may lead to an inherent problem caused by publication bias, that is, a strong bias to publish only studies that show significant results. 2,3 This bias can be mitigated through both the search methods selected and the statistical methods used.In the present study, we address the following 4 specific research topics: (1) the techniques systematic reviewers used to mitigate publication bias during the search process; (2) the statistical methods used to evaluate the existence of publication bias during data synthesis; (3) whether a difference existed in the frequency of publication bias evaluation among systematic reviews that did or did not endorse the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline; and (4) for systematic reviews not reporting a publication bias evaluation, whether there was sufficient information contained within the published report to conduct an independent evaluation, and if so, the findings of such evaluations.

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“…Benign paroxysmal positional vertigo (BPPV), the most frequent cause of vertigo, has an annual incidence ranging from 10.7 to 140 cases per 100 000 inhabitants [1] and a lifetime prevalence of 2.4% [2]. According to one systematic review, between 4.3% and 39.5% of patients seen in primary care for dizziness had BPPV [3].…”

Section: Introductionmentioning

confidence: 99%

“…The treatment of choice for BPPV is the Epley manoeuvre (EM), whose effectiveness has been demonstrated in numerous studies and systematic reviews [1][17] [18] [19]. The EM is a canalith repositioning manoeuvre that has been associated with improved self-perceptions of disability among patients with BPPV [16] [20].…”

Section: Introductionmentioning

confidence: 99%

Impact of Epley manoeuvre on self-perceived disability: A randomised controlled trial in primary care

Muñoz

Moreno

Balboa

et al. 2020

Preprint

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Background: Posterior canal benign paroxysmal positional vertigo (pc-BPPV) causes physical, functional, and emotional impairment. The treatment of choice is the Epley manoeuvre (EM). The purpose of the study was to compare the impact of the EM and a sham manoeuvre in primary care on self-perceived disability.Method: Randomised, double-blind, sham-controlled clinical trial conducted in primary care with a follow-up of 1 year. Patients aged ≥18 years old diagnosed with pc-BPPV according to the Dix-Hallpike test (DHT) were randomised to an intervention (EM) group or a control (sham manoeuvre) group. The main study covariables were age, sex, history of depression and anxiety, presence of nystagmus in the DHT, patient-perceived disability assessed with the Dizziness Handicap Inventory-screening version (DHI-S). Data were analyzed using bivariate and multivariate mixed Tobit analyses. Results: Overall, 134 patients were studied: 66 in the intervention group and 68 in the control group. Median age was 52 years (interquartile range [IQR], 38.25–68.00 years) and 76.12% of the patients were women. The DHT triggered nystagmus in 40.30% of patients. The median total DHI-S score for the overall sample at baseline was 16 (IQR, 8.00–22.00); 16 [IQR, 10.5–24.0] vs 10 [6.0–14.0] for women vs men (P<0.001) and 16 [IQR, 10.0-24.0] vs 12 [IQR, 8.0–18.0] for patients without nystagmus vs those with nystagmus (P=0.033).Patients treated with the EM experienced a mean reduction of 2.03 points in DHI-S score over the follow-up period compared with patients in the sham group. Conclusion: Pc-BPPV affects the quality of life of primary care patients. A single EM can improve self-perceptions of disability by around 2 points on the DHI-S scale, Trial registration: ClinicalTrials.gov Identifier: NCT01969513. Retrospectively registered. First Posted: October 25, 2013. https://clinicaltrials.gov/ct2/show/NCT01969513

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Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) Executive Summary

Cited by 75 publications

References 20 publications

Aging with Cerebral Small Vessel Disease and Dizziness: The Importance of Undiagnosed Peripheral Vestibular Disorders

Aging with Cerebral Small Vessel Disease and Dizziness: The Importance of Undiagnosed Peripheral Vestibular Disorders

Assessment of Publication Bias and Systematic Review Findings in Top-Ranked Otolaryngology Journals

Impact of Epley manoeuvre on self-perceived disability: A randomised controlled trial in primary care

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