bppv vertigo guidelines

New Best Practice Guidelines Issued for BPPV, One of the Most Common Causes of Vertigo

ALEXANDRIA, VIRGINIA — On March 1st, the American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF) published an updated clinical practice guideline for healthcare providers on benign paroxysmal positional vertigo (BPPV).

The updated guideline, Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo, provides evidence-based recommendations to healthcare providers on diagnosis and treatment of BPPV. Additionally, the guideline offers important patient information regarding frequently asked questions about the condition.

Delays in the diagnosis and treatment of BPPV, one of the most common causes of vertigo, can have significant quality-of-life implications for both patients and caregivers.



“The significant incidence of BPPV, its impact on the daily lives of patients, and the wide diversity of diagnostic and therapeutic interventions for BPPV drove the need for an up-to-date practice guideline. In updating the guideline, it was our goal to do so utilizing a focused and transparent process, reconsidering more current evidence while ultimately factoring in BPPV treatments that result in improved quality-of-life for the patient.”

–Neil Bhattacharyya, MD, Guideline Update Group Chair


BPPV is defined as a disorder of the inner ear, characterized by repeated episodes of positional vertigo. According to AAO-HNSF, a primary complaint of dizziness accounts for an estimated 5.6 million clinic visits in the United States per year and between 17 and 42 percent of patients with vertigo ultimately receive a diagnosis of BPPV.


Impact and Cost of BPPV


According to AAO-HNSF, healthcare costs associated with the diagnosis of BPPV alone approach $2 billion per year. The primary outcome considered in updating the guideline was to address resolving the symptoms associated with BPPV. The secondary outcomes include improving accuracy of BPPV diagnosis, a more efficient return to regular activities and work for patients, decreased use of inappropriate medications and unnecessary diagnostic tests, reduction in recurrence of BPPV, and the reducing the number of adverse events associated with undiagnosed or untreated BPPV. 


It is estimated that it costs approximately $2,000 to diagnose BPPV and more than 65% of people with this condition will undergo potentially unnecessary diagnostic testing or therapeutic interventions.


AAO-HNSF also points out that BPPV is more common in older individuals. These older patients with BPPV have greater risk of falls, depression, and impairments of their daily activities.

Due to the increasing age of the US population, the incidence of BPPV is likely to increase over the next two decades.


What Significant Changes Have Been Made vs. Earlier Guidance?


Before the new update was released, the most recent BPPV guidelines were developed in 2008. The differences between the 2008 and 2017 guidelines include:

• New evidence from two clinical practice guidelines, 20 systematic reviews, and 27 randomized controlled trials
• Emphasis on patient education and shared decision-making
• Expanded action statement profiles to explicitly state quality improvement opportunities, confidence in the evidence, intentional vagueness, and differences of opinion
• Enhanced external review process to include public comment and journal peer review
• A new algorithm to clarify decision-making and action statement relationships
• New and expanded recommendations for the diagnosis and management of BPPV


The new update is endorsed by American Academy of Audiology (AAA), American Physical Therapy Association (APTA), and many other organizations.



Source: AAO-HNSF