BPPV – Effective Treatment Available? It Depends

Despite the well established safety and effectiveness of Canalith Repositioning, patients with BPPV rarely receive this treatment.  A 2002 German study reviewed the prior medical history via questionnaire in a group of patients with confirmed BPPV. They report that 51% admitted to recurrent symptoms over a mean duration of 3.2 years. Prior to correct diagnosis, eight percent were hospitalized, Cerebral imaging was performed on 42%, and Doppler ultrasonography was performed on 34%. Audiograms and caloric studies were ordered on 49% and 46%, respectively. Diagnostic positioning tests were performed on only 28%. In the primary care setting, physicians performed positional tests on only 2% of patients with later verified BPPV. Keep in mind that these were people complaining of positional vertigo

Treatment choices were also mostly ineffective. Only 4% were treated with CRP, and another 15% were given home based exercises. The remainder either received no treatment (39%), or treatment such as antivertigo medication (39%) that has been established as ineffective for BPPV. In a 2008 survey of PCP’s, less than half the respondents were familiar with or convinced of the effectiveness of Canalith Repositioning.

Newman-Toker et al. (2009) reviewed the records of 9,472 ED patients, and found that 7.4% were given a vestibular related diagnosis. They specifically reviewed the management decisions involving patients diagnosed with BPPV and acute peripheral vestibulopathy (such as vestibular neuronitis or labyrinthitis). While these represent the most common vestibular disorders, it was noted that management decisions employed differed very little between the two groups. Neuro-imaging (mostly CT scanning) and use of vestibular suppressant medication was used with equal frequency in both groups. Recent published clinical guidelines recommend against the use of these two management strategies in patients diagnosed with BPPV.

 

 

About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.