Persistent Postural-Perceptual Dizziness-A Systematic Review of the Literature for the Balance Specialist

Otol Neurotol. 2018 Dec;39(10):1291-1303. doi: 10.1097/MAO.0000000000002010.


Objective: To present a systematic review of the current data on persistent postural-perceptual dizziness (PPPD), a useful and relatively new diagnosis for a disorder that has previously been known by many different names. In addition, to discuss diagnostic criteria and management strategies for this condition with the otologist in mind.

Data sources: CINAHL, Embase, PubMed, Medline, PsycINFO, PubMed, Google Scholar.

Review method: The phrase "persistent postural-perceptual dizziness" and its acronym "PPPD" were used.

Results: From 318 articles, 15 were selected for full analysis with respect to PPPD. Most were case-control studies, with one consensus paper from the Bárány Society available. Overall, the pathophysiology of PPPD remains relatively poorly understood, but is likely to be a maladaptive state to a variety of insults, including vestibular dysfunction and not a structural or psychiatric one. Cognitive behavioral therapy, vestibular rehabilitation, selective serotonin uptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs) all seem to have a role in its management.

Conclusions: PPPD is useful as a diagnosis for those treating dizziness as it helps to define a conglomeration of symptoms that can seem otherwise vague and allows for more structured management plans in those suffering from it.

Publication types

  • Systematic Review

MeSH terms

  • Dizziness / physiopathology
  • Dizziness / therapy*
  • Humans
  • Perceptual Disorders / physiopathology
  • Perceptual Disorders / therapy*
  • Postural Balance*