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://oto.sagepub.com/content/139/5_suppl/S47Theonlineversionofthisarticlecanbefoundat: DOI:10.1016/j.otohns.2008.08.0222008139:S47Otolaryngology--HeadandNeckSurgeryLindaT.Schuring,RobertW.P.Steiner,SusanL.WhitneyandJenissaHaidariRosenfeld,AlanL.Desmond,JerryM.Earll,TerryD.Fife,DrewC.Fuller,JamesO.Judge,NancyR.Mann,RichardM.NeilBhattacharyya,ReginaldF.Baugh,LauraOrvidas,DavidBarrs,LeoJ.Bronston,StephenCass,AraA.Chalian,Clinicalpracticeguideline:Benignparoxysmalpositionalvertigo Publishedby: AmericanAcademyofOtolaryngology-HeadandNeckSurgerycanbefoundat:Otolaryngology--HeadandNeckSurgeryAdditionalservicesandinformationfor : : : : WhatisThis? -Nov1,2008VersionofRecordbyguestonAugust25,2014oto.sagepub.comDownloadedfrombyguestonAugust25,2014oto.sagepub.comDownloadedfromguide.medlive.cnGUIDELINESClinicalpracticeguideline:BenignparoxysmalpositionalvertigoNeilBhattacharyya,MD,ReginaldF.Baugh,MD,LauraOrvidas,MD,DavidBarrs,MD,LeoJ.Bronston,DC,MAppSc,StephenCass,MD,MPH,AraA.Chalian,MD,AlanL.Desmond,AuD,JerryM.Earll,MD,TerryD.Fife,MD,DrewC.Fuller,MD,MPH,JamesO.Judge,MD,NancyR.Mann,MD,RichardM.Rosenfeld,MD,MPH,LindaT.Schuring,MSN,RN,RobertW.P.Steiner,MD,PhD,SusanL.Whitney,PhD,andJenissaHaidari,MPH,Boston,MA;Temple,TX;Rochester,MN;Phoenix,AR;LaCross,WI;Denver,CO;Philadelphia,PA;Princeton,WV;Washington,DC;Baltimore,MD;Hartford,CT;Detroit,MI;Brooklyn,NY;NewSmyrnaBeach,FL;Louisville,KY;Pittsburgh,PA;andAlexandria,VAOBJECTIVES:Thisguidelineprovidesevidence-basedrecom-mendationsonmanagingbenignparoxysmalpositionalvertigo(BPPV),whichisthemostcommonvestibulardisorderinadults,withalifetimeprevalenceof2.4percent.Theguidelinetargetspatientsaged18yearsorolderwithapotentialdiagnosisofBPPV,evaluatedinanysettinginwhichanadultwithBPPVwouldbeidentified,monitored,ormanaged.ThisguidelineisintendedforallclinicianswhoarelikelytodiagnoseandmanageadultswithBPPV.PURPOSE:Theprimarypurposesofthisguidelinearetoim-provequalityofcareandoutcomesforBPPVbyimprovingtheaccurateandefficientdiagnosisofBPPV,reducingtheinappro-priateuseofvestibularsuppressantmedications,decreasingtheinappropriateuseofancillarytestssuchasradiographicimagingandvestibulartesting,andtopromotetheuseofeffectivereposi-tioningmaneuversfortreatment.Increatingthisguideline,theAmericanAcademyofOtolaryngology—HeadandNeckSurgeryFoundationselectedapanelrepresentingthefieldsofaudiology,chiropracticmedicine,emergencymedicine,familymedicine,ge-riatricmedicine,internalmedicine,neurology,nursing,otolaryn-gology–headandnecksurgery,physicaltherapy,andphysicalmedicineandrehabilitation.RESULTS:Thepanelmadestrongrecommendationsthat1)cli-niciansshoulddiagnoseposteriorsemicircularcanalBPPVwhenvertigoassociatedwithnystagmusisprovokedbytheDix-Hallpikemaneuver.Thepanelmaderecommendationsagainst1)radiographicimaging,vestibulartesting,orbothinpatientsdiagnosedwithBPPV,unlessthediagnosisisuncertainorthereareadditionalsymptomsorsignsunrelatedtoBPPVthatwarranttesting;and2)routinelytreatingBPPVwithvestibularsuppressantmedicationssuchasantihistaminesorbenzodiazepines.Thepanelmaderecommendationsthat1)ifthepatienthasahistorycompatiblewithBPPVandtheDix-Hallpiketestisnegative,clinic-iansshouldperformasupinerolltesttoassessforlateralsemicircularcanalBPPV;2)cliniciansshoulddifferentiateBPPVfromothercausesofimbalance,dizziness,andvertigo;3)cliniciansshouldques-tionpatientswithBPPVforfactorsthatmodifymanagementinclud-ingimpairedmobilityorbalance,CNSdisorders,lackofhomesup-port,andincreasedriskforfalling;4)cliniciansshouldtreatpatientswithposteriorcanalBPPVwithaparticlerepositioningmaneuver(PRM);5)cliniciansshouldreassesspatientswithin1monthafteraninitialperiodofobservationortreatmenttoconfirmsymptomreso-lution;6)cliniciansshouldevaluatepatientswithBPPVwhoareinitialtreatmentfailuresforpersistentBPPVorunderlyingperipheralvestibularorCNSdisorders;and7)cliniciansshouldcounselpatientsregardingtheimpactofBPPVontheirsafety,thepotentialfordiseaserecurrence,andtheimportanceoffollow-up.Thepanelofferedasoptionsthat1)cliniciansmayoffervestibularrehabilitation,eitherself-administeredorwithaclinician,fortheinitialtreatmentofBPPVand2)cliniciansmayofferobservationasinitialmanagementforpatientswithBPPVandwithassuranceoffollow-up.ThepanelmadenorecommendationconcerningaudiometrictestinginpatientsdiagnosedwithBPPV.DISCLAIMER:Thisclinicalpracticeguidelineisnotintendedasasolesourceofguidanceinmanagingbenignparoxysmalpositionalvertigo.Rather,itisdesignedtoassistcliniciansbyprovidinganevidence-basedframeworkfordecision-makingstrategies.Theguide-lineisnotintendedtoreplaceclinicaljudgementorestablishapro-tocolforallindividualswiththiscondition,andmaynotprovidetheonlyappropriateapproachtodiagnosingandmanagingthisproblem.©2008AmericanAcademyofOt