#BENIGN POSITIONAL VERTIGO TREATMENT EPLEY MANEUVER UPDATE#

#BENIGN POSITIONAL VERTIGO TREATMENT EPLEY MANEUVER UPDATE#

Action Statements The update group made strong recommendations that clinicians should (1) diagnose posterior semicircular canal BPPV when vertigo associated with torsional, upbeating nystagmus is provoked by the Dix-Hallpike maneuver, performed by bringing the patient from an upright to supine position with the head turned 45° to one side and neck extended 20° with the affected ear down, and (2) treat, or refer to a clinician who can treat, patients with posterior canal BPPV with a canalith repositioning procedure. Other outcomes considered include minimizing costs in the diagnosis and treatment of BPPV, minimizing potentially unnecessary return physician visits, and maximizing the health-related quality of life of individuals afflicted with BPPV. Secondary outcomes considered include an increased rate of accurate diagnoses of BPPV, a more efficient return to regular activities and work, decreased use of inappropriate medications and unnecessary diagnostic tests, reduction in recurrence of BPPV, and reduction in adverse events associated with undiagnosed or untreated BPPV. The primary outcome considered in this guideline is the resolution of the symptoms associated with BPPV. The target patient for the guideline is aged ≥18 years with a suspected or potential diagnosis of BPPV. The guideline is intended for all clinicians who are likely to diagnose and manage patients with BPPV, and it applies to any setting in which BPPV would be identified, monitored, or managed. Purpose The primary purposes of this guideline are to improve the quality of care and outcomes for BPPV by improving the accurate and efficient diagnosis of BPPV, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary testing such as radiographic imaging, and increasing the use of appropriate therapeutic repositioning maneuvers. Changes from the prior guideline include a consumer advocate added to the update group new evidence from 2 clinical practice guidelines, 20 systematic reviews, and 27 randomized controlled trials enhanced emphasis on patient education and shared decision making a new algorithm to clarify action statement relationships and new and expanded recommendations for the diagnosis and management of BPPV. Objective This update of a 2008 guideline from the American Academy of Otolaryngology-Head and Neck Surgery Foundation provides evidence-based recommendations to benign paroxysmal positional vertigo (BPPV), defined as a disorder of the inner ear characterized by repeated episodes of positional vertigo. 16 16 American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA.15 15 Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA.

14 14 Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.

13 13 Department of Otorhinolaryngology, Health Sciences Center, University of Oklahoma, Oklahoma City, Oklahoma, USA.

12 12 Department of Health Management and Systems Science and Department of Family and Geriatric Medicine, School of Public Health and Information Science, University of Louisville, Louisville, Kentucky, USA.

11 11 Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Central Florida, Orlando, Florida, USA.

10 10 Alabama Hearing and Balance Associates, Inc, Birmingham, Alabama, USA.

9 9 Ear, Nose & Throat Specialists of Northern Virginia, PC, Arlington, Virginia, USA.

8 8 Vestibular Disorders Association, Portland, Oregon, USA.7 7 Intermountain Hearing and Balance Center, Salt Lake City, Utah, USA.6 6 Barrow Neurological Institute and College of Medicine, University of Arizona, Phoenix, Arizona, USA.5 5 Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA.4 4 Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.3 3 Department of Otolaryngology, Virginia Mason Medical Center, Seattle, Washington, USA.2 2 Department of Otolaryngology, School of Medicine and Public Health, University of Colorado, Aurora, Colorado, USA.1 1 Department of Otolaryngology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA.

Benign positional vertigo treatment epley maneuver