Benign paroxysmal positional vertigo: clinical characteristics of dizzy patients referred to a Falls and Syncope Unit

Lawson, John; Johnson, Ida M.; Bamiou, Doris‐Eva; Newton, JL

doi:10.1093/qjmed/hci057

Cited by 66 publications

(62 citation statements)

References 13 publications

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“…Patients with BPPV may not specifically describe true vertigo and may complain of light-headedness or nonspecific dizziness; thus, the clinician may need to initially consider a broader differential diagnosis. 32 BPPV has been described as occurring in conjunction with, or as a consequence of, other vestibular disorders as well, such as Ménière's disease and vestibular neuritis. 87 Therefore, clinicians must consider the possibility of >1 vestibular disorder being present in any patient who does not clearly have the specific symptoms of a single vestibular entity.…”

Section: 80mentioning

confidence: 99%

“…The propensity for falling may actually be a significant motivating factor for patients to be referred for evaluation and management of BPPV. 32 The risk of falls and the fear of falls are significant considerations in the management of the elderly who suffer from chronic dizziness. 117 In study of 120 elderly patients with chronic vestibular disorders, 36.7% carried the diagnosis of BPPV.…”

Section: Action Statement Profile For Statementmentioning

confidence: 99%

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Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)

Bhattacharyya¹,

Gubbels

Schwartz

et al. 2017

Otolaryngol.--head neck surg.

585

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: 80mentioning

confidence: 99%

Section: Action Statement Profile For Statementmentioning

confidence: 99%

Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)

Bhattacharyya¹,

Gubbels

Schwartz

et al. 2017

Otolaryngol.--head neck surg.

585

776

View full text Add to dashboard Cite

show abstract

“…The main aetiologies of dizziness include vestibular or central vertigo (45-54%), disequilibrium (2-16%), presyncope (4-14%), psychiatric disorders (9-21%), hyperventilation (1-23%), multiple causes (12-13%) and unknown (8-19%). 7,8,[18][19][20] In reviewing the literature, we could not find reference to postural BP changes in patients complaining of nonspecific dizziness. Patients in our study were preselected, The numbers in the table represent patients presenting the symptom.…”

Section: Discussionmentioning

confidence: 99%

Nonspecific dizziness: frequency of supine hypertension associated with hypotensive reactions on head-up tilt

et al. 2005

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The clinical syndrome of supine hypertension associated with orthostatic hypotension (OH) in given individuals is recognized by specialists, but is underdiagnosed in the community. The objective of this study was to assess supine hypertension associated with hypotensive reactions on head-up tilt (SH-HRT) among patients evaluated for nonspecific dizziness. Consecutive patients with nonspecific dizziness were studied with a 10-min supine 30-min head-up tilt test. Supine hypertension (SH) was diagnosed when supine systolic blood pressure (SBP) was X140 mmHg and/or supine diastolic blood pressure (DBP) was X90 mmHg. Hypotensive reactions on tilt (HRT) were diagnosed when SBP decreased by X30 mmHg on tilt and/or DBP decreased by X15 mmHg. Of 430 patients tested, 42 (9.8%) had SH-HRT. The median age was 67 years; 37 had a pretest diagnosis of hypertension, with treatment.The median supine BP was 162/90 mmHg; the median nadir BP on tilt was 118/78 mmHg. Four SH-HRT patterns were recognized: (I) SH with typical neurogenic OH (n ¼ 6), (II) SH with vasovagal reaction on tilt (n ¼ 4), (III) SH with sustained HRT (n ¼ 28), and (IV) SH with mixed orthostatic-vasovagal reaction on tilt (n ¼ 4). Dizziness on tilt occurred in 25% of patients category III (SH with sustained HRT), while appearing universally in other SH-HRT patterns. In conclusion, nonspecific dizziness may be the chief complaint in patients with SH-HRT, a disorder often unrecognized by clinicians. Different patterns of SH-HRT on HUTT may reflect different aberrations in cardiovascular homeostasis and may require differentiated management strategies.

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“…We echo the call for 'effi cient, seamless movement' between geriatrician-led falls clinics and balance/vertigo services, led by audiology teams, audiovestibular physicians or ENT specialists. 24 In addition we argue that all local falls pathways should include guidance for referral for specialist assessment of those with suspected vestibular pathology.…”

Section: Diagnostic Vestibular Assessmentsmentioning

confidence: 99%

Vestibular impairment in older people frequently contributes to dizziness as part of a geriatric syndrome

Ahearn

Umapathy

2015

Clinical Medicine

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Research to identify whether dizziness is a geriatric syndrome has largely overlooked often treatable vestibular causes. To ascertain the degree to which vestibular and other causes of dizziness interact in older people, an eight-month retrospective case-note review was undertaken in patients aged ≥65 years referred with dizziness or imbalance to an audiovestibular medicine clinic. Of 41 patients aged 65-93 years old, 15 (37%) had multiple symptom triggers, 23 (56%) had recent dizzinessrelated falls, 24 (59%) and 10 (24%) had peripheral and central vestibular causes for dizziness respectively, whereas 6 (15%) had both. Sixteen (39%) had benign paroxysmal positional vertigo, of which 13 (32%) had an additional peripheral vestibular impairment. Twenty-six (63%) had other (general medical/ cardiac) causes; of these 13 (50%) also had vestibular causes. Polypharmacy, orthostatic hypotension, psychotropic drug use and anxiety were common contributory factors. Vestibular causes of dizziness contribute to a multifactorial geriatric syndrome. All patients with dizziness and falls should have a vestibular assessment (especially peripheral) to improve quality of life and reduce falls.

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Benign paroxysmal positional vertigo: clinical characteristics of dizzy patients referred to a Falls and Syncope Unit

Abstract: BPPV is a potentially curable cause for dizziness in older people. Older people are frequently referred directly to Falls units, who will be seeing increasing numbers of patients with dizziness. A high index of suspicion allows early identification and treatment of this condition.

Cited by 66 publications

References 13 publications

Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)

Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)

Nonspecific dizziness: frequency of supine hypertension associated with hypotensive reactions on head-up tilt

Vestibular impairment in older people frequently contributes to dizziness as part of a geriatric syndrome

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