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AAO32: Standard BPPV Management

AAO32: Standard BPPV Management

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High Priority: Yes; Appropriate Use
Percentage of BPPV patients who received vestibular testing, imaging, and antihistamine or benzodiazepine medications (Inverse Measure).

Patients diagnosed with posterior canal BPPV.

Denominator Exclusions:
Patients whose diagnosis of BPPV was made after vestibular testing, imaging, or antihistamine or benzo prescribed are not included in the eligible population for the denominator.

Denominator Exceptions:
For numerator component A patients may be excluded if they have:

• Negative Dix-Hallpike maneuver
• Dizziness that lasts longer than one minute
• Postural or gait abnormalities
• Transient dizziness that is unresponsive to repositioning

For numerator component B patients may be excluded if they have:

• Atypical BPPV (anterior canal, relapsing BPPV (To be captured via search term processing this exclusion should
be written as “Patient has relapsing BPPV.”), BPPV associated with other neurological conditions, or severe multicanal BPPV)
• Focal deficit or unilateral hearing loss
• Vision changes
• Trauma history
• Recent surgery

For numerator component C patients may be excluded if they have:

• Patient refuses other treatment options
• Severe symptoms during positioning
• Nausea or Vomiting during positioning
• Patient requires prophylaxis
• Clinical indication for long-term use present (e.g., anxiety disorder)


A. Patients with BPPV referred for vestibular testing by the encounter provider
B. Patients with BPPV referred, recommended, or ordered a CTA, CT, MRA, or MRI by the encounter provider
C. Patients with BPPV prescribed antihistamine or benzodiazepine medication by the encounter provider
D. Total patient performance on the 3 above components (All-or-nothing calculation)

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