Is web-guided diagnosis and treatment feasible and effective in recurrent benign paroxysmal positional vertigo?

Web-guided diagnosis and treatment of recurrent benign paroxysmal positional vertigo (BPPV) proved efficacious in a randomised parallel-group study in South Korea.

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo with frequent recurrences. Dizziness/vertigo is the third most common symptom prompting emergency department visits, accounting for 3.5% to 11% of total emergency department visits, with an annual cost estimated at $3.9 million in the US in 2011. BPPV is believed to be caused by dislodged otoconia that enter the semicircular canals. In response to a change in the static orientation of the head with respect to gravity, the otolithic debris moves to a new position within the semicircular canals, leading to a false sense of rotation.

The canalith repositioning maneuver (CRM) can effectively treat BPPV. CRM results in immediate resolution of BPPV in about 80% of patients after a single application, and the success rate increases to 92% with repetition. By virtue of its relative ease, patients may attempt the CRM, but accurately identifying the affected canal is essential since the CRM is canal specific.

Kim et al conducted a multicenter, randomized, parallel-group, double-blind trial to assess the efficacy of diagnosis and treatment of BPPV using a web-based system at 4 medical centers in South Korea.

In their study of 585 enrolled patients, 128 (21.9%) experienced positional vertigo, with no significant difference between the treatment and control groups. The mean recurrence interval was 179.8 days during follow-up. Of 128 patients with presumed recurrence of BPPV during the study period, 19 (14.5%) could not access the web-based system when they experienced positional vertigo again and were instructed to visit the clinic.

In the intention-to-treat analysis, 72.4%in the treatment group and 42.9% in the control group reported vertigo resolution after application of the web-based system.

In the per-protocol analysis, 82.4% in the treatment group and 51.7% in the control group reported vertigo resolution.Posterior canal BPPV showed a resolution in 96.4% and horizontal canal BPPV in 72.2%.

None of the patients who used the web-based treatment system reported adverse events other than nausea, vomiting, or mild headache. No patients experienced a fall or fall-related adverse events during CRM self-administration.

This trial proved the efficacy of a web-guided self-treatment system for recurrent BPPV. Use of this system may play an important role in telemedicine for vestibular disorders.

Reference: Hyo-Jung Kim, PhD; Ji-Soo Kim, MD, PhD; Kwang-Dong Choi, MD, PhD; et alJAMA Neurologydoi:10.1001/jamaneurol.2022.4944