Background: Vertigo is defined as an illusion of motion caused by a mismatch of information between the visual, vestibular and somatosensory systems. The most common diagnosis associated with whirling vertigo is benign paroxysmal positional vertigo (BPPV), which affects approximately 3.4% of patients older than 60 years of age. Objective: This paper aims to educate primary care providers on how to diagnose BPPV by performing canalith repositioning maneuvers at the initial point of care. Timely treatment of BPPV in the primary care office is believed to reduce healthcare costs by way of limiting unnecessary diagnostic testing and lowering referrals for specialty care. Immediate treatment is also believed to improve the quality of healthcare delivery for the vertigo patient by reducing morbidity and resolving the condition without the need for referrals or imaging. Population Health: A review of the literature finds that delayed diagnosis and treatment of BPPV is associated with a host of deleterious effects on patients. Population health impacts include increased rates of anxiety and depression; loss of work and/or change of career paths; inappropriate use of medications or emergency care resources; decreased access to healthcare services; increased healthcare costs; and reduced quality of care. Diagnosis: A history of positional vertigo and evidence of nystagmus with Dix-Hallpike positioning confirms the diagnosis. A detailed description of the performance of this test is elucidated. Treatment: The observed nystagmus is analyzed and classified based on directionality. Treatment can be initiated immediately with canalith repositioning maneuvers.

Introduction: Radiofrequency (RF) microneedling requires minimal downtime; however, patients’ tolerance of the procedural pain can limit cosmetic results. The goal of this study was to determine the patient tolerance of RF microneedling with sufentanil sublingual tablet (SST) 30 μg and topical local anesthetic compared with topical local anesthetic alone. Materials and Methods: The study was a one-way crossover study of patients undergoing RF microneedling of the face or abdomen. Topical local anesthetic was applied 45 minutes prior to the initial procedure to one side of the face or abdomen (control side), followed by topical local anesthetic and SST administered 45 and 30 minutes, respectively, prior to the procedure on the opposite side (SST-treated side). The primary endpoint was patient completion of the procedure with additional endpoints of Richmond Agitation Sedation Scale scores, patient and provider satisfaction ratings, vital signs, oxygen saturation levels, and adverse events. Results: A total of 51 patients were enrolled averaging 44.8 ± 11.1 (SD) years of age. Forty-five percent of patients successfully completed the control side compared with 96% of patients successfully completing the SST-treated side ( P < .001). Patients were less restless or agitated during the SST-treated side (6%) compared with the control side (51%; P < .001). Patient and provider satisfaction scores were significantly improved with SST ( P < .001). Vital signs remained stable with SST treatment compared with the control side. Discussion: The SST is a safe and effective sublingual analgesic allowing patients to be awake and alert while increasing patient tolerance of RF microneedling as well as patient and provider satisfaction with the procedure. Conclusion: The SST is a novel analgesic that can be used in office-based settings with appropriate safety equipment available.