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Miniseminar to Preview New Guideline for BPPV

Benign paroxysmal positional vertigo (BPPV) is the most common vestibular problem treated by physicians. An AAO-HNSF panel has updated the BPPV clinical practice guideline, which is expected to be published early next year. The recommendations from the proposed guideline will be previewed in a Miniseminar Sunday.

“AAO-HNSF Clinical Practice Guideline (Update): Benign Paroxysmal Positional Vertigo” will be presented from 1:00 pm-2:00 pm Sunday in Ballroom 6C.

The current guideline was published in 2008, so it was due for an update, even though most of its recommendations remain valid, said Neil Bhattacharyya, MD, chair of the guideline update panel.

“We have had a significant increase in the body of evidence for BPPV, with 20 new systematic reviews and 27 controlled trials,” said Dr. Bhattacharyya, professor of otology & laryngology at Harvard Medical School. “The new guideline has a patient algorithm to help clinicians at the point of care. We are emphasizing more patient education and shared decision-making, which is a big topic in newer guidelines.”

The original guideline focused on posterior canal BPPV while the update adds more information about lateral canal BPPV because of an increase in diagnostic information and treatment recommendations for it.

“What we really want to do with this guideline is emphasize a very effective treatment option that oftentimes can be done in the same sitting as the initial diagnosis,” Dr. Bhattacharyya said. “This guideline goes through the positional maneuvers that can effectively cure the vertigo in upwards of 80 percent of patients.

“We emphasized the canalith repositioning procedure (CRP), which now has a ‘strong recommendation’ for treatment because the evidence is overwhelmingly positive about its effectiveness.”

Another recommendation is to forgo imaging studies in obvious cases of BPPV.

“For cost savings and safety, we are recommending against getting any imaging in straightforward cases,” Dr. Bhattacharyya said. “They don’t need a CT scan or MRI. We also recommended against treating with medicines that are vestibular suppressants because they have side effects, and CRP is very effective.”

One final change is the addition of a Key Action Statement that patients do not need to have their activities restricted following treatment for BPPV.

Other speakers at the Miniseminar will be members of the guideline panel:

  • Samuel P. Gubbels, MD, director of the University of Colorado School of Medicine Health Hearing and Balance Center
  • Seth R. Schwartz, MD, MPH, medical director for the Listen for Life Center at Virginia Mason Medical Center
  • Michael D. Seidman, MD, Head & Neck Surgery Center of Florida

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