Smartphone telemedical emergency department consults for screening of nonacute dizziness

Abstract

Objectives/Hypothesis Each year, the United States spends over $4 billion on emergency department visits for evaluation of dizziness. Benign paroxysmal positional vertigo (BPPV) is a common cause of dizziness that can easily be diagnosed by observing characteristic eye movements during the Dix‐Hallpike test (DHT). The DHT is easily performed; however, interpretation requires more advanced training. This may be part of the reason it is not commonly performed in emergency departments, and instead, patients undergo costly imaging tests. We evaluated whether smartphone‐based video recordings of DHT could be assessed telemedically for screening of nonacute dizziness. Study Design Feasibility study. Methods Dizzy patients underwent objective vestibular testing, but also had videos of their eye movements recorded via a smartphone during the DHT. The videos were remotely reviewed by two neuro‐otologists for BPPV screening and were compared to objective and in‐person exam findings. Results Overall, 30 dizzy patients were evaluated with seven cases of BPPV. The sensitivity for diagnosing BPPV via a smartphone‐recording of eye movements of the DHT was 92.86%, with a specificity of 100% and a negative predictive value of 97.87%. Conclusions Our initial proof‐of‐concept study shows that remote screening of BPPV is possible with high specificity. Because the DHT is easily taught, having a remote otolaryngologist interpret the resulting eye movements may increase usage of the test and may lead to cost savings. Level of Evidence 4 Laryngoscope, 129:466–469, 2019

The Impact of the COVID-19 Pandemic on Follow-Ups for Vertigo/Dizziness Outpatients

“…[28][29][30] The WHO also recommends the use of information and communication technology to maintain and improve health, so-called e-Health. 31 In the ENT field related to vertigo/dizziness, online medicine may include video-lectured diagnosis and canalith repositioning treatment for BPPV, 32 stress less life guidance for MD, and vestibular rehabilitation for VN and SDV. After the COVID-19 pandemic ends, it will be time to prepare for an advanced way of providing medical care, not only for the disease itself but also for the mental distress behind persistent symptoms.…”

Teleconsultation and Teletreatment Protocol to Diagnose and Manage Patients with Benign Paroxysmal Positional Vertigo (BPPV) during the COVID-19 Pandemic

“…The authors concluded that the images obtained by this portable equipment were satisfactory and useful to the diagnosis process. 22 A research on health care was conducted in a resourcerestricted, post-Katrina Hurricane South Louisiana. The authors claimed that telemedicine was a viable delivery model for neurotology care.…”

Telemedicine in neurology: current evidence

“…The search for the terms "telemedicine AND (dizziness OR vertigo)" returned 25 articles in the PubMed database. Three addressed the applications of telemedicine in the diagnosis of vestibular and balance disorders 36,37,38,39 . Thus, we note that research in this area is still very scarce.…”

“…Regarding recurrent vertigo, a study with 37 patients evaluated the use of a video of the patient's eyes during the Dix-Hallpike maneuver, recorded by smartphone, in the diagnosis of vestibular disorders 36 . Seven patients were diagnosed with BPPV, the sensitivity of the method for this diagnosis being 92.86% and the specificity 100%.…”