Unrecognized benign paroxysmal positional vertigo in elderly patients

Oghalai, John S.; Manolidis, Spiros; Barth, Justine L.; Stewart, Michael G.; Jenkins, Herman A.

doi:10.1067/mhn.2000.105415

Cited by 187 publications

(242 citation statements)

References 15 publications

(12 reference statements)

Supporting

Mentioning

226

Contrasting

Unclassified

Order By: Relevance

“…In the elderly, the diagnosis of BPPV is more frequent owing to associated co-morbidities 8 . In this age range, the disease normally has higher morbidity when associated with falls, which represents added risk to health and increased risk of mortality 40,41 . It is interesting to notice that even though the elderly are more exposed to the disease, we can observe that efficacy of repositioning maneuver is the same as the one observed in other age ranges, in accordance with previous reports 35 .…”

Section: Resultsmentioning

confidence: 99%

Restrições posturais não interferem nos resultados da manobra de reposição canalicular

Simoceli

Bittar

Greters

2005

Rev. Bras. Otorrinolaringol.

View full text Add to dashboard Cite

Beni gn Paroxysmal Positional Vertigo (BPPV) is a frequentcause of dizziness and despite of the excellent results with its treatment, there is some controversy about management. Aim: To assess the efficacy of Epley Maneuver with and without post-maneuver restrictions. Study Design: Prospective randomized. Material and Method: Fifty patients presenting BPPV of the posterior semicircular canal, treated with Epley Maneuver and divided into two groups: study group -23 patients -with post-maneuver restrictions, and control group -27 patients -without post-maneuver restrictions. Results: No significant difference was found between the studied and the control group. Conclusion: Post-maneuver restrictions do not influence the efficacy of Epley Maneuver for BPPV management.

show abstract

Section: Resultsmentioning

confidence: 99%

Restrições posturais não interferem nos resultados da manobra de reposição canalicular

Simoceli

Bittar

Greters

2005

Rev. Bras. Otorrinolaringol.

View full text Add to dashboard Cite

show abstract

“…35 Use of medications in BPPV is associated with failure to provide proven treatment (canalith repositioning), 14,35 which, in turn, may increase the risk of falls and depression, especially among older patients. 15,55 For those with APV, underuse of corticosteroids is probably associated with unnecessary morbidity. Chronic dizziness, imbalance, head motion intolerance, and oscillopsia associated with poorly compensated unilateral vestibulopathy occur after untreated APV in about half of patients, 56,57 but corticosteroids reduce nonrecovery roughly threefold.…”

Section: Discussionmentioning

confidence: 99%

Disconnect Between Charted Vestibular Diagnoses and Emergency Department Management Decisions: A Cross‐sectional Analysis From a Nationally Representative Sample

Newman‐Toker

Camargo

Hsieh

et al. 2009

Academic Emergency Medicine

View full text Add to dashboard Cite

Objectives: The most common vestibular disorders seen in the emergency department (ED) are benign paroxysmal positional vertigo (BPPV) and acute peripheral vestibulopathy (APV; i.e., vestibular neuritis or labyrinthitis). BPPV and APV are two very distinct disorders that have different clinical presentations that require different diagnostic and treatment strategies. BPPV can be diagnosed without imaging and is treated with canalith-repositioning maneuvers. APV sometimes requires neuroimaging by magnetic resonance imaging (MRI) to exclude posterior fossa stroke mimics and should be treated with vestibular sedatives and corticosteroids. We sought to determine if emergency physicians (EPs) apply best practices to diagnose and treat these common vestibular disorders.Methods: This was a cross-sectional study of ED visits from the National Hospital Ambulatory Medical Care Survey (NHAMCS). A weighted sample of U.S. ED visits (1993ED visits ( -2005 was used. Patients at least 16 years of age who were given a final ED diagnosis of BPPV (International Classification of Diseases, 9th Revision [ICD-9], 386.11) or APV (ICD-9 386.12 or 386.3x) comprised the study population. The frequency of imaging and drug therapy in those diagnosed as BPPV or APV versus controls was the main outcome measure.Results: A total of 9,472 dizzy patient visits were sampled over 13 years (weighted estimate 33.6 million U.S. ED visits over that period). A weighted estimate of 2.5 million patients (7.4%) were given a vestibular diagnosis, mostly BPPV (weighted 0.2 million) or APV (weighted 1.9 million). Patients given BPPV (19%) and APV (19%) diagnoses were more likely to undergo imaging (all by computed tomography [CT]) than controls (7%; p < 0.001). Patients given BPPV (58%) and APV (70%) diagnoses were more likely to receive meclizine than controls (0.1%; p < 0.001). Corticosteroid administration was rarely documented (2% BPPV, 1% APV).Conclusions: Patients given a vestibular diagnosis in the ED may not be managed optimally. Patients given BPPV and APV diagnoses undergo imaging (predominantly CT) with equal frequency, suggesting overuse of CT (BPPV) and probably underuse of MRI (APV). Most patients diagnosed with BPPV are given meclizine, which is not indicated. Specific therapy for APV (corticosteroids) is probably underutilized. Educational initiatives and clinical guidelines merit consideration.ACADEMIC EMERGENCY MEDICINE 2009; 16:970-977 ª

show abstract

“…[16][17][18] However, studies of select patients have estimated a prevalence of 900 per 10,000. [19][20][21] Others have reported a lifetime prevalence of 2.4%, a 1-year prevalence of 1.6%, and a 1-year incidence of 0.6%. 22 Women are more frequently affected than men, with a female:male ratio of 2.2 to 1.5:1.…”

Section: Health Care Burdenmentioning

confidence: 99%

Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)

Bhattacharyya¹,

Gubbels

Schwartz

et al. 2017

Otolaryngol.--head neck surg.

518

689

View full text Add to dashboard Cite

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...

show abstract

Unrecognized benign paroxysmal positional vertigo in elderly patients

Cited by 187 publications

References 15 publications

Restrições posturais não interferem nos resultados da manobra de reposição canalicular

Restrições posturais não interferem nos resultados da manobra de reposição canalicular

Disconnect Between Charted Vestibular Diagnoses and Emergency Department Management Decisions: A Cross‐sectional Analysis From a Nationally Representative Sample

Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)

Contact Info

Product

Resources

About