The importance of repeated clinical examination in patients with suspected benign paroxysmal positional vertigo

Otol Neurotol. 2009 Apr;30(3):356-8. doi: 10.1097/MAO.0b013e3181967b9c.


Objective: We enable patients with recurrent vertigo, who were examined during an asymptomatic period, to be reexamined on an urgent basis when the symptoms reappear. In this study, we tried to establish the usefulness of this arrangement.

Study design: Retrospective case review.

Setting: Outpatient clinic.

Intervention: We reviewed the medical records of patients treated at our dizziness clinic for benign paroxysmal positional vertigo (BPPV) during 1999-2008.

Main outcome measures: The rate and characteristics of patients with BPPV where the diagnosis was established on reexamination.

Results: : Among 464 patients treated for BPPV, 364 were seen during asymptomatic period, whereas in 100 patients (21.5%), the diagnosis was established during reexamination. In 86 of them, BPPV was suspected during the first visit, and in the remaining patients, another diagnosis was initially assumed.The mean period between the first visit to final diagnosis was 14.9 months. Seven percent of patients had to be examined repeatedly until signs of BPPV could be elicited. Seventy-nine percent of patients had a laboratory examination before the diagnosis was established.

Conclusion: At a specialized clinic, the method of reexamination in patients with recurrent vertigo and a normal neurotologic examination between attacks are useful for clarifying the diagnosis. A high confidence is justified when suspecting the diagnosis of BPPV between the attacks. Auxiliary examinations can be reserved for cases with an atypical history or abnormal findings on neurotologic testing.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Ambulatory Care Facilities
  • Dizziness / drug therapy
  • Electrocardiography
  • Female
  • Humans
  • Male
  • Meniere Disease / diagnosis
  • Meniere Disease / therapy
  • Middle Aged
  • Nystagmus, Physiologic / physiology
  • Recurrence
  • Retrospective Studies
  • Vertigo / diagnosis*
  • Vertigo / therapy
  • Young Adult