Benign paroxysmal positional vertigo (BPPV) is a condition characterized by brief spinning episodes that occur with a rapid change in head position. Although considered benign, BPPV can have many personal, social, health, and financial implications. Yet, providers in a variety of settings are frequently mismanaging the condition leading to incomplete resolution of symptoms, decreased quality of life, reduced productivity, and increased healthcare spending. This study sought to better understand why providers fail to follow current evidence-based BPPV guidelines and the impact BPPV-specific education could have on improving their practices. Questionnaires assessing BPPV-specific knowledge as well as inquiring about provider barriers to following guidelines were distributed to 11 providers in a rural Colorado mountain town. A 45-minute education session was then presented to providers in order to update them on current recommendations. Following the education, similar questionnaires reassessing provider knowledge of BPPV guidelines were disseminated. Results showed an improvement in provider knowledge as evidenced by an increase in the percentage of correct response scores following the education session compared to pre-education. Additionally, providers identified difficulty in interpreting nystagmus patterns as well and remembering how to perform the various maneuvers as major barriers to guidelines adherence. Future BPPV education should focus on these two barriers to ensure better guidelines adherence. In order to evaluate long-term practice changes following the intervention, a 16-month retrospective chart analysis was performed in a small rural emergency department where three of the participating providers from the education session worked. Results from the chart analysis were inconclusive due to a scarcity of patient encounters during the post-intervention period. Future studies should be performed with a larger participation pool and longer analysis period to better evaluate the effectiveness of BPPV-specific education on improving provider practices. The ultimate goals of providing BPPV education are to promote a quicker resolution of patient’s symptoms, improve their quality of life, reduce unnecessary healthcare spending, while still allowing for appropriate provider compensation.

The incidence data provided by previous investigations of peripheral vestibulopathy in patients with benign paroxysmal positional vertigo (BPPV) are quite variable. This variability may be explained, in part, by the otologic history of the patients included in these studies. Specifically, patients with a prior history of other otologic disease and BPPV should be more likely to present with peripheral vestibulopathy than patients without no prior history of otologic disease and BPPV. The purpose of this study was to determine the incidence of peripheral vestibulopathy in these two groups of BPPV patients. Caloric responses were analyzed for two groups of patients with posterior canal BPPV, those with a positive history of otologic disease and those with a negative history of otologic disease. Data were analyzed retrospectively for 157 BPPV patients. Patients with a positive history of otologic disease exhibited a greater incidence of peripheral vestibulopathy than the negative history group. The positive history group, on average, also exhibited a larger unilateral weakness than those patients in the negative history group. We conclude that patients with BPPV and a prior history of otologic disease are more likely to present with peripheral vestibulopathy than patients with BPPV and no history of otologic disease.

Professional research project (Au.D.)--University of South Florida, 2003. / Title from PDF of title page. / Document formatted into pages; contains 24 pages. / Includes bibliographical references. / ABSTRACT: The incidence data provided by previous investigations of peripheral vestibulopathy in patients with benign paroxysmal positional vertigo (BPPV) are quite variable. This variability may be explained, in part, by the otologic history of the patients included in these studies. Specifically, patients with a prior history of other otologic disease and BPPV should be more likely to present with peripheral vestibulopathy than patients without no prior history of otologic disease and BPPV. The purpose of this study was to determine the incidence of peripheral vestibulopathy in these two groups of BPPV patients. Caloric responses were analyzed for two groups of patients with posterior canal BPPV, those with a positive history of otologic disease and those with a negative history of otologic disease. Data were analyzed retrospectively for 157 BPPV patients. Patients with a positive history of otologic disease exhibited a greater incidence of peripheral vestibulopathy than the negative history group. The positive history group, on average, also exhibited a larger unilateral weakness than those patients in the negative history group. We conclude that patients with BPPV and a prior history of otologic disease are more likely to present with peripheral vestibulopathy than patients with BPPV and no history of otologic disease. / Mode of access: World Wide Web.

Benign paroxysmal positional vertigo (BPPV) is a specific type of short-duration vertigo that is provoked by changes in head position and usually lasts less than one minute. It is a common vestibular pathology that can have significant effects on patient safety, quality of life, and medical costs. Therefore, it is crucial that medical students are educated and trained to facilitate and coordinate care of patients who may have undiagnosed BPPV. Because there is evidence to suggest that physicians—specifically primary care physicians—may not be properly equipped in their education to manage patients with BPPV, the purpose of this study was to investigate medical students’ evaluations of their preparedness to provide evidence-based care in the diagnosis and treatment of BPPV. An anonymous survey was administered via email to medical students in their fourth and final year of medical school at East Tennessee State University’s Quillen College of Medicine. This survey includes statements about the evidence-based Clinical Practice Guideline on BPPV provided by the American Academy of Otolaryngology. Respondents rated the degree to which they agreed or disagreed with how prepared they felt to address each item using a 5-point response scale from “strongly disagree” to “strongly agree.” Of the 70 students in the current fourth year class, 41 (59%) completed the survey. Students felt prepared for some aspects of diagnosing and treating BPPV, especially with regard to their general knowledge of BPPV, its impact on patients’ lives, and the options available to manage it. They felt less prepared to know when or if it is appropriate to recommend additional testing, imaging, or medication. They did not feel confident in their ability to perform the maneuvers to diagnose and treat BPPV. Overall, these results suggest medical students have a good foundation in their knowledge of BPPV. These results also propose topics to support more specialized training during their residencies to build upon the foundational knowledge obtained during their didactic training and optimize diagnosis and management of BPPV.

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Background: The Mountain Home Veterans Affairs (VA) Medical Center has been diagnosing and treating veterans with benign paroxysmal positional vertigo (BPPV) for almost 2 decades. The clinic protocol includes a 2-week follow-up visit to determine the treatment outcome of the canalith repositioning treatment (CRT). To date, the characteristics of BPPV and treatment efficacy have not been reported in a cohort of veterans with BPPV. Purpose: To determine the prevalence and characteristics of veterans diagnosed with BPPV in a Veterans Affairs Medical Center Audiology Clinic and to examine treatment outcomes. Research Design: Retrospective chart review. Study Sample: A total of 102 veterans who tested positive for BPPV in the Vestibular Clinic at the Mountain Home VA Medical Center from March 2010 to August 2011. Results: In 102 veterans who were diagnosed with BPPV, the posterior semicircular canal was most often involved (75%), motion-provoked vertigo was the most common symptom (84%), and the majority (43%) were diagnosed with BPPV in their sixth decade. The prevalence of BPPV in the Audiology Vestibular Clinic was 15.6%. Forty-one percent of veterans reported a symptom onset within 12 months of treatment for BPPV; however, 36% reported their symptoms began > 36 months prior to treatment. CRT was effective (negative Dix–Hallpike/roll test) in most veterans (86%) following 1 treatment appointment (M = 1.6), but more than half reported incomplete symptom resolution (residual dizziness) at the follow-up appointment. Eighteen percent of veterans experienced a recurrence (M = 1.8 years; SD = 1.7 years). Conclusions: The characteristics and treatment outcomes of BPPV in our veteran cohort was similar to what has been reported in the general population. Future work should focus on improving the timeliness of evaluation and treatment of BPPV and examining the time course and management of residual dizziness.