![]() 3 However, the Dix-Hallpike test is not frequently used in the ED setting, where vertigo is a common clinical presentation. The Dix-Hallpike test is the standard for the diagnosis of BPPV it is nearly 100% specific to BPPV and has a sensitivity of 88%. Practice parameter: simple maneuver is best therapy for com mon form of vertigo. Source: Reprinted with permission from: Mitka M. The canalith repositioning maneuver being performed on a patient with benign paroxysmal positional vertigo. Approximately 89% to 95% of BPPV cases involve the posterior canal because of its orientation to gravity. The theory of BPPV centers around canalithiasis, in which otoconia break free into the semicircular canals of the inner ear. Average length of stay for patients treated in our ED with a diagnosis of BPPV is 260 minutes. The time from the examination by the physician to the patient's discharge was 133 minutes. This patient's overall length of stay in the ED was 180 minutes. The patient rated her satisfaction of care in the ED 10 out of 10 on a Likert scale, with 1 meaning not satisfied and 10 meaning very satisfied. The patient had sought follow-up treatment with an ear, nose, and throat physician but had received no additional treatment because her symptoms resolved. 1999 341(21):1590-1596.Ī follow-up phone call was placed to the patient 30 days after discharge. Source: Reprinted with the permission from: Furman JM, Cass SP. (B) The patient is quickly moved into a supine position with her head extended and rotated 45 degrees toward her ear. (A) The patient's head is turned toward her ear while she is in a sitting position. Illustration of the Dix-Hallpike test being performed on a patient suspected of having benign paroxysmal positional vertigo. At discharge, the patient received a prescription for meclizine hydrochloride (25 mg every 8 hours) for treatment of her breakthrough vertigo and received a referral for outpatient vestibular rehabilitation. ![]() No medications were given to the patient while she was in the ED. Before discharge, the physician repeated the Dix-Hallpike test, the results of which were normal for both right and left sides. Thirty minutes after treatment, the patient felt well enough to go home. Thirty minutes after treatment, she rated her dizziness as 1 out of 10 her nausea rating remained the same. Fifteen minutes after treatment, the patient rated her dizziness as 2 out of 10 and her nausea as 3 out of 10. Visual analog ratings were repeated 15 and 30 minutes after treatment. After completion of the treatment, the patient rated her dizziness as 1 out of 10 and her nausea as 2 out of 10 on the visual analog scale. The physical therapist treated the patient with a canalith repositioning maneuver for the left, posterior, semicircular canal ( Figure 2). After the Dix-Hallpike test, the patient rated both her dizziness and nausea as 10 out of 10 on a visual analog scale. The physical therapist repeated the Dix-Hallpike test, the findings of which were consistent with those of the first test conducted by the emergency physician. Examination revealed normal balance and no gross gait deviations. A physical therapist was contacted to evaluate the patient. Dix-Hallpike testing on the right side was normal and on the left side revealed an upbeating, left torsional nystagmus lasting approximately 15 seconds ( Figure 1).Īcute vertigo secondary to BPPV was diagnosed based on the examination findings. All other pertinent physical examination findings were normal. Resting nystagmus was not present, and cranial nerves II through XII were intact. Physical examination revealed the patient to be alert and oriented to person, place, and time. ![]() The patient's past medical history was notable for vertigo, for which she received vestibular rehabilitation. Report of CaseĪ 38-year-old woman presented to our ED with acute onset of vertigo, nausea, and vomiting, all exacerbated with head movement. However, several reviews 1 on the management of vertigo have indicated that medications currently used for the treatment of vertigo do not have well-established curative or prophylactic value and are not suitable for long-term treatment. Once the clinician determines that there is no central etiology, patients are typically treated with benzodiazepine, antihistamine, or anticholinergic agents. 1 The ED standard of care for patients presenting with vertigo is to rule out serious medical causes based on patient history, physical examination, and diagnostic workup. 1 According to the Vestibular Disorders Association, approximately 50% of elderly patients who present with a chief complaint of dizziness have BPPV. Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder, accounting for approximately 20% of all vertigo cases. Vertigo is a common complaint among patients who seek care in the emergency department (ED).
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