https://acpinternist.org/weekly/archives/2023/01/24/4.htm

Telemedicine appears effective for recurrent benign paroxysmal positional vertigo

In a South Korean trial of patients with previous cases of benign paroxysmal positional vertigo, 72.4% of those randomized to a web-based diagnostic questionnaire and a video explaining the canalith repositioning maneuver reported vertigo resolution.


A web-based system was effective for self-diagnosis and treatment of recurrent benign paroxysmal positional vertigo (BPPV), a recent trial found.

To determine the efficacy of a web-based program for diagnosis and treatment of recurring BPPV, researchers conducted a randomized, controlled, parallel-group, double-blind trial in South Korea from July 2017 to February 2020. They applied a previously developed six-question survey that could diagnose the involved canal and type of BPPV with an accuracy of 71.2%. The questionnaire's first three items screened for BPPV, and the next three determined the subtype of BPPV based on the positioning maneuver that induces more intense vertigo.

A total of 585 patients diagnosed and treated for BPPV were followed for recurrence for at least two years, until February 2022. The primary outcome was self-reported resolution of positional vertigo after a canalith repositioning maneuver (CRM). Secondary outcomes included difficulties and requirement for assistance when using the web-based program and any falls or other adverse events related to CRM. Results were published Jan. 17 by JAMA Neurology.

Patients were randomly assigned to the treatment or control group. All patients were instructed to access the study website when they experienced a recurrence of positional vertigo. The 292 patients in the treatment group (mean age, 60.3 years; 64% women) completed a questionnaire for diagnosis and received a video clip for self-administration of CRM according to BPPV subtype. The 293 patients in the control group (mean age, 61.1 years; 71% women) received a video clip for self-administration of CRM according to the type of BPPV that had been diagnosed at study enrollment without completing the questionnaire. All patients repeated the CRM one hour later. The efficacy of CRM was assessed by an independent investigator during a telephone interview one to three days after CRM completion.

Overall, 128 (21.9%) patients experienced BPPV recurrence (58 in the treatment group and 70 in the control group), and 109 (85.2%) successfully used the web-based system. In the intention-to-treat analysis, 42 of 58 patients in the treatment group and 30 of 70 patients in the control group (72.4% vs. 42.9%) reported vertigo resolution. Patients reported using the web-based program without difficulty. Most patients (88 of 109 [80.7%]) were able to use it by themselves, but 21 (19.3%) required some help. Patients who needed help were older than those who did not (mean age, 68.2 vs. 58.0 years).

“Given the effectiveness of the questionnaire-based diagnosis and self-administration of the CRM in BPPV, BPPV appears to be a vestibular disorder that is highly appropriate for telemedicine and digital therapeutics,” the authors wrote. “Thus, the system adopted in this study may be used for primary care physicians, particularly when making a tentative diagnosis over the telephone or during an office visit when a provocative maneuver is equivocal or cannot be done.”