Research Gaps - Benign Paroxysmal Positional Vertigo (BPPV)
As determined by the panel's review of the literature, assessment of current clinical practices, and determination of evidence gaps, research needs were determined as follows:
- Conduct prospective epidemiological studies of the incidence, prevalence, and burden of untreated BPPV among older adults.
- Conduct prospective diagnostic cohort studies to determine the sensitivity, specificity, and predictive values for the Dix-Hallpike maneuvers in the diagnosis of posterior canal BPPV. Such studies should also determine the latency duration and duration of subjective vertigo and objective nystagmus with the maneuver. Diagnostic cohort studies should be extended to non-specialist environments including the primary care and emergency department settings.
- Conduct prospective diagnostic cohort studies to determine the sensitivity, specificity, and predictive values for the supine roll test for lateral canal BPPV. Diagnostic cohort study should be extended to nonspecialty environments including the primary care and emergency department settings.
- Conduct diagnostic and cost-effectiveness studies to identify which subsets of patients, according to specific history or physical examination findings, should be submitted for additional vestibular testing and/or radio-graphic imaging in the setting of presumed BPPV.
- Conduct diagnostic and cost-effectiveness studies evaluating the utility and costs of audiometry in the diagnostic evaluation of BPPV.
- 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.
- Define the natural history of untreated posterior canal BPPV and lateral canal BPPV to determine proper endpoints for clinical trials and follow-up assessments.
- Determine the optimal number of CRPs and the time interval between performances of CRP for patients with posterior canal BPPV.
- Conduct RCTs of CRP for posterior canal BPPV with emphasis on 1) larger sample sizes, 2) (faster) time to resolution of symptoms with CRP rather than resolution of symptoms at a set endpoint in time, 3) trials in the primary care and/or emergency department settings, and 4) outcomes such as quality of life, return to work, reduced fall risk.
- Conduct RCTs of PRMs for lateral canal BPPV to determine the effectiveness of proposed treatments. Time to resolution rather than resolution at a fixed endpoint should also be emphasized.
- Conduct RCTs comparing PRMs to vestibular rehabilitation including comparisons among different vestibular rehabilitation options.
- Conduct cost-effectiveness studies for the potential advantages of earlier intervention based on earlier diagnosis and earlier symptom resolution with expedient PRMs for BPPV. Both direct health care and global economic costs require assessment.
- Conduct extended cohort studies with longer follow-up to determine if measures such as self-performance of CRP or longitudinal vestibular rehabilitation decrease recurrence rates for BPPV or complications from BPPV such as falls.
- Conduct studies on the functional impact of BPPV as they relate to home safety, work safety and absences, and driving risks.
- Conduct epidemiological studies on the rates of falls with BPPV as an underlying cause/diagnosis.
- Develop and validate a disease-specific quality-of-life measure for BPPV to assess treatment outcomes.