Practice Guidelines for BPPV - Neurology Section

Vestibular SIG Newsletter BPPV Special Edition
Additional BPPV practice guidelines that the AAO-
HNS recommend include:
Practice Guidelines (cont.)
• Assessing persons with BPPV for other
causes of imbalance, vertigo and dizziness
as well as additional modifiable factors
that may influence treatment parameters
such as co-morbidities, fall risk and
anxiety.
• Abstaining from obtaining radiographic
imaging, and vestibular testing in persons
diagnosed with BPPV who do not have
other findings.
• Evaluating persons thought to have BPPV
who do not respond to treatments for
peripheral vestibular or CNS involvement.
• Educating persons with BPPV on the
impact of this condition on safety,
potential for recurrence and importance of
follow-up.
• Offering vestibular rehabilitation, either
through self-treatment, or with a skilled
clinician for the treatment of BPPV.
• Reassessing persons with BPPV one
month after initial treatment to confirm
symptom resolution or provide additional
treatment and/or referral.
Evidence Quality Key
Grade Evidence quality
10
The guidelines described above were supported by either
Grade B or Grade C research. In addition to these
recommendations, the use of audiometric testing was
also examined in the AAO-HNS guidelines. On study
described, conducted by Stewart et al, (1999) found that
the audiogram was the most cost-effective test for
vertigo as compared to electronystagmography,
posturography, MRI and blood tests. However, because
traditional BPPV does not involve hearing loss and
because waiting for audiometry may delay treatment for
BPPV, no recommendation was made for audiometric
testing (Grade D).
In summary, both the AAN and AAO-HNS have
conducted extensive reviews of the literature to
recommend practice guidelines for treating persons with
BPPV. Although some practice guidelines had enough
evidence to be either recommended or not, some
common practices continue to lack enough quality
evidence to conclusively be described as beneficial or
not for this patient population. Continued research and
collaboration between disciplines treating persons with
BPPV will add to this body of knowledge and further
define patient practice guidelines. This practice will
more enable more efficient and efficacious care for
persons with BPPV.
A Well-designed randomized controlled trials or diagnostic studies performed on a population similar to target
population.
B Randomized controlled trials or diagnostic studies with minor limitations; observational studies present that provide
consistent evidence
C Observational studies only (case-control and cohort design)
D Expert opinion, case reports, reasoning from first principles (bench research/animal studies)
X Situations when validating studies unable to be performed due to clear preponderance of benefit over harm
Table adopted from: Bhattacharyya et al. 2008: p S5