Experience from a multidisciplinary ?Dizzy? clinic

Ap, Bath; Rm, Walsh; Ranalli, Paul J.; Tyndel, Felix; Ml, Bance; R, Mai; Ja, Rutka

doi:10.1016/s0196-0709(00)80081-2

Cited by 81 publications

(77 citation statements)

References 0 publications

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“…Among complex patients referred for subspecialty evaluation of BPPV, such atypical or unclear nystagmus findings may approach 13% among patients with diagnoses suspicious for BPPV. 150 BPPV is relatively frequently associated with additional vestibular pathology. Symptoms associated with an underlying, previously present chronic vestibular dysfunction may persist following appropriate treatment for BPPV, even if the treatment is effective in resolving the specific complaint of positional vertigo.…”

Section: Action Statement Profile For Statement 3amentioning

confidence: 99%

Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)

Bhattacharyya¹,

Gubbels

Schwartz

et al. 2017

Otolaryngol.--head neck surg.

566

776

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Objective. This update of a 2008 guideline from the American Academy of Otolaryngology-Head and Neck Surgery Foundation provides evidence-based recommendations to benign paroxysmal positional vertigo (BPPV), defined as a disorder of the inner ear characterized by repeated episodes of positional vertigo. Changes from the prior guideline include a consumer advocate added to the update group; new evidence from 2 clinical practice guidelines, 20 systematic reviews, and 27 randomized controlled trials; enhanced emphasis on patient education and shared decision making; a new algorithm to clarify action statement relationships; and new and expanded recommendations for the diagnosis and management of BPPV.Purpose. The primary purposes of this guideline are to improve the quality of care and outcomes for BPPV by improving the accurate and efficient diagnosis of BPPV, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary testing such as radiographic imaging, and increasing the use of appropriate therapeutic repositioning maneuvers. The guideline is intended for all clinicians who are likely to diagnose and manage patients with BPPV, and it applies to any setting in which BPPV would be identified, monitored, or managed. The target patient for the guideline is aged ≥18 years with a suspected or potential diagnosis of BPPV. The primary outcome considered in this guideline is the resolution of the symptoms associated with BPPV. Secondary outcomes considered include an increased rate of accurate diagnoses of BPPV, a more efficient return to regular activities and work, decreased use of inappropriate medications and unnecessary diagnostic tests, reduction in recurrence of BPPV, and reduction in adverse events associated with undiagnosed or untreated BPPV. Other outcomes considered include minimizing costs in the diagnosis and treatment of BPPV, minimizing potentially unnecessary return physician visits, and maximizing the health-related quality of life of individuals afflicted with BPPV.Action Statements. The update group made strong recommendations that clinicians should (1) diagnose posterior semicircular canal BPPV when vertigo associated with torsional, upbeating nystagmus is provoked by the Dix-Hallpike maneuver, performed by bringing the patient from an upright to supine position with the head turned 45° to one side and neck extended 20° with the affected ear down, and (2) treat, or refer to a clinician who can treat, patients with posterior canal BPPV with a canalith repositioning procedure. The update group made a strong recommendation against postprocedural postural restrictions after canalith repositioning procedure for posterior canal BPPV. The update group made recommendations that the clinician should (1) perform, or refer to a clinician who can perform, a supine roll test to assess for lateral semicircular canal BPPV if the patient has a history compatible with BPPV and the Dix-Hallpike test exhibits horizontal or no nystagmus; (2) differentiate...

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Section: Action Statement Profile For Statement 3amentioning

confidence: 99%

Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)

Bhattacharyya¹,

Gubbels

Schwartz

et al. 2017

Otolaryngol.--head neck surg.

566

776

View full text Add to dashboard Cite

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“…Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder both in unselected patients [ 7 ] and in migraineurs [ 41 ] presenting to a dizziness clinic. Migraine is three times more common in patients with idiopathic BPPV than in patients with BPPV secondary to trauma or surgical procedures [ 29 ].…”

Section: Benign Paroxysmal Positional Vertigomentioning

confidence: 99%

Epidemiology of vertigo, migraine and vestibular migraine

2009

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Both migraine and vertigo are common in the general population with lifetime prevalences of about 16% for migraine and 7% for vertigo. Therefore, a concurrence of the two conditions can be expected in about 1.1% percent of the general population by chance alone. However, recent epidemiological evidence suggests that the actual comorbidity is higher, namely 3.2 %. This can be explained by the fact that several dizziness and vertigo syndromes occur more frequently in migraineurs than in controls including benign paroxysmal positional vertigo, Meniere's disease, motion sickness, cerebellar disorders and anxiety syndromes which may present with dizziness. In addition, there is increasing recognition of a syndrome called vestibular migraine (VM), which is vertigo directly caused by migraine. VM affects more than 1% of the general population, about 10% of patients in dizziness clinics and at least 9% of patients in migraine clinics.Clinically, VM presents with attacks of spontaneous or positional vertigo lasting seconds to days. Migrainous accompaniments such as headache, phonophobia, photophobia or auras are common but not mandatory. Cochlear symptoms may be associated but are mostly mild and non-progressive. During acute attacks one may find central spontaneous or positional nystagmus and, less commonly, unilateral vestibular hypofunction. In the symptom-free interval, vestibular testing adds little to the diagnosis as findings are mostly minor and non-specific. In the absence of controlled studies, treatment of VM is adopted from the migraine sphere comprising avoidance of triggers, stress management as well as pharmacotherapy for acute attacks and prophylaxis.

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“…Peripheral (e.g., inner ear or vestibular nerve) vestibular disorders (PVD) are the second most common cause to dizziness (Yin, Ishikawa, Wong, & Shibata, 2009). Some authors report that peripheral vestibular disorders account for 40%-65% of those seeking help for dizziness (Bath et al, 2000). The three characteristic symptoms of peripheral vestibular disorders are: vertigo, lightheadedness and giddiness, and feeling unsteady.…”

Section: Introductionmentioning

confidence: 99%