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.
PATIENT EDUCATION
It is important to remember that vertigo is a symptom, while BPPV is a diagnosis. Therefore, merely informing the patient that he or she has vertigo is not sufficient. The patient (and his/her family, if present) should be educated about the cause of the patient’s vertigo. The patient should be provided with information about BPPV that is delivered both verbally and through printed health education materials.
The chances and unpredictability of recurrence should be discussed. Ideally, the patient should be instructed to make a same-day follow-up appointment for treatment should symptoms recur. Patients, particularly the elderly, should be counseled about the risk for falls; fall risk assessment questionnaires with recommendations for prevention of injury are helpful.4
The patient with BPPV should be provided with instructions, including diagrams, of how to perform modified CRP exercises at home. Helpful videos are available on the Internet for patient use. For example, the University of Michigan has created videos for a patient diagnosed with BPPV of the right ear (www.youtube.com/watch?v=BY4UeRmTYmA) and the left ear (www.youtube.com/watch?v=lh72suV2p20).
In self-administered CRP, the patient moves through the same positions used for in-office CRP, except that the patient’s head is extended over the edge of a pillow.24 Patients should be instructed to stop the home exercises once they are symptom free for 24 h or more.
FOLLOW-UP AND REFERRAL
The need for follow-up varies depending on the patient’s response to treatment and the incidence of recurrence. Clinical practice guidelines recommend follow-up within a month of initial observation or treatment to reassess and confirm resolution of symptoms.4 Referral to specialists for treatment should be considered without delay if the primary care clinician does not feel confident treating BPPV and/or is unsure of the diagnosis based on the results of the Dix-Hallpike test, particularly if the patient’s quality of life is affected and safety is a concern.
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