American Speech-Language-Hearing Association

EBP Compendium: Summary of Clinical Practice Guideline

American Academy of Otolaryngology-Head and Neck Surgery Foundation
Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo

Bhattacharyya, N., Baugh, R. F., et al. (2008).
Otolaryngology- Head and Neck Surgery, 139(5 Suppl 4), S47-81.

AGREE Rating: Highly Recommended

Description:

This guideline provides recommendations for the assessment and management of benign paroxysmal positional vertigo (BPPV). The target audience of this guideline is clinicians who are likely to diagnose or manage BPPV. Levels of evidence are provided and defined by a strong recommendation, recommendation, option or no recommendation. Recommendation statements are based on the benefits/harms of the approach and the quality of supporting evidence. A Strong Recommendation Statement is provided when the approach clearly exceeds the harms or when the harms clearly exceed the benefits (Strong Recommendation Against) and a Recommendation Statement is provided when the benefits exceed the harms or when the harms exceed the benefits (Recommendation Against). An Option Statement is based on evidence that is suspect or from well-done studies that show little advantage of one approach over another. A No Recommendation Statement is provided when there is both a lack of pertinent evidence and an unclear balance between benefits and harms. 

Recommendations:

  • Assessment/Diagnosis
    • Assessment Areas
      • Hearing & Balance - Evidence regarding the diagnostic or prognostic value of audiometric testing for patients with BPPV is insufficient (No Recommendation Statement).
    • Assessment Instruments
      • Dix Hallpike Maneuver & Roll Test - The Dix-Hallpike maneuver is recommended to diagnosis posterior canal BPPV. If the Dix-Hallpike test is negative, the authors recommend the supine roll test be considered to diagnosis lateral canal BPPV (Recommendation Statement).
      • Radiographic Imaging
        • Radiographic testing should not be used with patients diagnosed with BPPV (Recommendation Against Statement).
        • Radiographic testing may be warranted if diagnosis is uncertain or additional symptoms or signs unrelated to BPPV warrant testing.
      • Vestibular Function Test
        • Vestibular function testing is not recommended as part of the diagnostic assessment of BPPV (Recommendation Against Statement).
        • Vestibular function testing may be warranted if individual presents with atypical nystagmus, suspected additional pathology, or does not respond to repositioning treatment.
  • Treatment
    • Vestibular Rehabilitation
      • General Findings
        • Observation may be warranted as initial management for patients with BPPV (Option Statement).
        • Vestibular rehabilitation may be warranted as an initial treatment of BPPV (Option Statement).
        • Reassessment should be completed within 1 month after initial observation or treatment to confirm symptom resolution (Recommendation Statement).
      • Repositioning Maneuvers
        • Repositioning maneuvers may be warranted as an initial treatment of BPPV (Recommendation Statement).
        • Reposition maneuvers included the canalith repositioning procedure (CRP) and the liberatory (Semont’s) maneuver.
        • There was insufficient evidence directly comparing maneuvers. However, the authors found the Semont maneuver was “more effective than no treatment or Brandt-Daroff exercises in relieving symptoms of BPPV” (p. S66). 

Keywords: Balance Disorders; BPPV; Vestibular Rehabilitation

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Added to Compendium: November 2011

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