Improving diagnosis and treatment of benign paroxysmal positional vertigo

Background: Vertigo is defined as an illusion of motion caused by a mismatch of information between the visual, vestibular and somatosensory systems. The most common diagnosis associated with whirling vertigo is benign paroxysmal positional vertigo (BPPV), which affects approximately 3.4% of patients older than 60 years of age. Objective: This paper aims to educate primary care providers on how to diagnose BPPV by performing canalith repositioning maneuvers at the initial point of care. Timely treatment of BPPV in the primary care office is believed to reduce healthcare costs by way of limiting unnecessary diagnostic testing and lowering referrals for specialty care. Immediate treatment is also believed to improve the quality of healthcare delivery for the vertigo patient by reducing morbidity and resolving the condition without the need for referrals or imaging. Population Health: A review of the literature finds that delayed diagnosis and treatment of BPPV is associated with a host of deleterious effects on patients. Population health impacts include increased rates of anxiety and depression; loss of work and/or change of career paths; inappropriate use of medications or emergency care resources; decreased access to healthcare services; increased healthcare costs; and reduced quality of care. Diagnosis: A history of positional vertigo and evidence of nystagmus with Dix-Hallpike positioning confirms the diagnosis. A detailed description of the performance of this test is elucidated. Treatment: The observed nystagmus is analyzed and classified based on directionality. Treatment can be initiated immediately with canalith repositioning maneuvers.