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Diagnosis and treatment choices of suspected benign paroxysmal positional vertigo: current approach of general practitioners, neurologists, and ENT physicians

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Benign paroxysmal positional vertigo (BPPV) is a frequently underdiagnosed cause of vertigo, potentially due to the underuse of diagnostic and therapeutic canalith repositioning procedures (CRPs). We aimed to investigate self-reported use of the diagnostic and therapeutic approach to BPPV patients by Lithuanian neurologists, ear, nose, and throat (ENT) physicians, and general practitioners (GPs), and to explore potential reasons for the underuse of the maneuvers.

Methods

Neurologists, ENT physicians, and GPs were invited to complete a written questionnaire focused on diagnostic and therapeutic practices related to BPPV. Between-group differences and associations between responses were analyzed statistically.

Results

In total, 97 neurologists, 85 ENT physicians and 142 GPs (21.1%, 26.8%, and 5.7%, respectively, of all corresponding licensed Lithuanian physicians) completed the questionnaire. 24% of neurologists, 33% ENT physicians and 50% GPs do not perform diagnostic maneuvers for patients with suspected BPPV, and 28%, 61%, and 84%, respectively, do not perform CRPs. Years of clinical experience was a negative predictor of CRP performance [OR 0.97 (95% CI 0.95–0.99), p = 0.001]. Frequent reasons for not performing CRPs were time taken for the procedure, fear of provoking symptoms, and lack of knowledge. All physicians frequently ordered additional imaging or consultations for suspected BPPV and reported prescribing a range of medications.

Conclusions

A significant proportion of Lithuanian neurologists, ENT physicians, and GPs do not employ diagnostic maneuvers and CRPs for BPPV patients, contrary to established guidelines. Lack of expertise and time available is a common culprit that leads to unnecessary drug prescribing and investigation.

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Acknowledgements

We would like to thank the Lithuanian Institute of Hygiene, Health Information Centre for sharing summary data on vertigo patients’ hospitalizations and diagnoses in Lithuania.

Funding

The study received no funding.

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Authors and Affiliations

  1. Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland

    Agnė Ulytė

  2. Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania

    Agnė Ulytė, Rytis Masiliūnas, Dalius Jatužis & Kristina Ryliškienė

  3. Faculty of Medicine, Vilnius University, Vilnius, Lithuania

    Domantas Valančius

  4. Clinic of Ear, Nose, Throat, and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania

    Aistė Paškonienė & Eugenijus Lesinskas

  5. Department of Clinical and Motor Neuroscience, 33 Queen Square, WC1N 3BG, London, UK

    Diego Kaski

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  1. Agnė Ulytė
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Correspondence to Agnė Ulytė.

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The study protocol was approved by the local bioethics committee. The study did not involve patient participants and was performed in accordance with the 1964 Helsinki Declaration and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

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Ulytė, A., Valančius, D., Masiliūnas, R. et al. Diagnosis and treatment choices of suspected benign paroxysmal positional vertigo: current approach of general practitioners, neurologists, and ENT physicians. Eur Arch Otorhinolaryngol 276, 985–991 (2019). https://doi.org/10.1007/s00405-019-05313-y

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