Research Gaps - Benign Paroxysmal Positional Vertigo (BPPV)
As determined by the panel’s review of the literature, assessment of current clinical practices, and evidence gaps, research needs were determined as follows:
- Conduct diagnostic and cost-effectiveness studies to identify which subsets of patients, based on specific history or physical examination findings, should be submitted for additional vestibular testing and/or radiographic imaging in the setting of presumed BPPV.
- Diagnostic and cost-effectiveness studies evaluating the utility and costs of audiometry in the diagnostic evaluation of BPPV are needed.
- Determine whether education and application of clinical diagnostic criteria for BPPV will change physician behavior in terms of anticipated decreases in ordering of diagnostic tests.
- Determine the optimal number of CRPs and the time interval between performance of CRPs for patients with posterior canal BPPV.
- Cost-effectiveness studies for the potential advantages of earlier intervention based on earlier diagnosis and earlier symptom resolution with expedient CRPs for BPPV are needed. Both direct health care and global economic costs require assessment.
- Extended cohort studies with longer follow-up to determine if measures such as self-performance of CRP or longitudinal VR decrease recurrence rates for BPPV or complications from BPPV such as falls.
- Determine whether vestibular therapy after the CRP offers additional benefits over CRP alone in select patient populations.
- Studies on the functional impact of BPPV as they relate to home safety, work safety and absences, and driving risks.
- Epidemiologic studies on the rates of falls with BPPV as an underlying cause/diagnosis.
- Assess the impact of BPPV on quality of life for those affected with general quality-of-life and/or dizziness-specific quality-of-life metrics.
- Develop and validate a disease-specific quality-of-life measure for BPPV to assess treatment outcomes.
- Perform studies to evaluate the effect of structured versus “as needed” follow-up regimens on the outcomes of patients with BPPV.
- Clarify and standardize the terms used to describe repositioning maneuvers for BPPV of the lateral canal to enable meaningful comparison of their efficacy.
- Perform studies to evaluate the effectiveness of mastoid vibration in the treatment of BPPV.
- Epidemiologic studies to characterize the relative risk of factors associated with the development of BPPV, such as osteoporosis, dental procedures, and other devices that deliver cranial vibrations (massage devices, motorized toothbrushes, etc).
- Identify patient- and treatment-related risk factors for the development of recalcitrant BPPV.
- Perform studies to evaluate the sensitivity, specificity, and predictive values of the available examination maneuvers to determine the presence and laterality of BPPV affecting the anterior semicircular canal.
- Perform studies to characterize the accuracy of diagnostic maneuvers for posterior and lateral canal BPPV and to evaluate the treatment outcomes for patients with BPPV seen in nonspecialty settings.