Vertigo: Diagnosis and Management
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Expires December 31, 2014
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Benign paroxysmal positional vertigo accounts for approximately 42% of cases of vertigo seen in primary care settings and is the single most common cause of vertigo in the United States. Our expert outlines an evidence-based approach to diagnosis, which results in an increase in desirable patient outcomes and a decrease in unnecessary tests and medications.
Benign paroxysmal positional vertigo accounts for approximately 42% of cases of vertigo seen in primary care settings and is the single most common cause of vertigo in the United States. Our expert outlines an evidence-based approach to diagnosis, which results in an increase in desirable patient outcomes and a decrease in unnecessary tests and medications.
Dizziness is a common complaint of patients seen in both the primary care setting and the emergency department (ED). Dizziness can be classified as vertigo, disequilibrium, presyncope, and lightheadedness. Psychiatric disorders can be the cause in as many as 16% of patients who present with dizziness.1
Vestibular vertigo is the most common type of dizziness and can result from peripheral vestibular causes and central vestibular causes.1 Peripheral vestibular causes include benign paroxysmal positional vertigo (BPPV), Ménière’s disease, vestibular neuronitis, labyrinthitis, vestibular schwannoma, perilymphatic fistula, superior semicircular canal dehiscence syndrome, and trauma.2 Central vestibular causes of vertigo include vestibular migraine, vertebrobasilar ischemic stroke, and vertebrobasilar insufficiency (transient ischemic attack).2 (For more information, see Pearson T. Ménière’s disease: a lifelong merry-go-round. Clinician Reviews. 2013;23[10]:38-43.)
BPPV accounts for approximately 42% of cases of vertigo in nonspecialty settings such as primary care and is the single most common cause of vertigo in the United States.3,4 Other common causes include vestibular neuritis (41% of cases), Ménière’s disease (10%), and vascular disease (3%).4
BPPV is a disorder of the inner ear that is characterized by repeated episodes of positional vertigo, a spinning sensation produced by changes in head position relative to gravity. The term benign implies a form of positional vertigo not due to any serious central nervous system (CNS) disorder and carries an overall favorable prognosis. The term paroxysmal describes the sudden and rapid onset of vertigo.4
BPPV typically involves either the posterior semicircular canal (by far the most common) or the lateral (horizontal) semicircular canal.5 BPPV involving the posterior semicircular canal comprises 85% to 95% of all cases of BPPV and is the focus of this article.6
BPPV can be diagnosed and treated by multiple clinical disciplines, and there is considerable variation in the management of BPPV across disciplines.4 Delays in diagnosis and treatment can directly affect patients’ quality of life as well as increase health care costs. Patients with BPPV often receive inappropriately prescribed medications, such as vestibular suppressants, and potentially unnecessary diagnostic tests.4,7-9 In many cases, diagnostic and treatment decisions in regard to BPPV are not guided by current evidence.4
On the next page: Epidemiology >>
