2017美国耳鼻咽喉头颈外科学会BPPV管理指南

1. V、PV、BPPV的定义：

2. BPPV管理指南流程：

3. 指南要点：

1a. Diagnosis of posterior semicircular canal BPPV
Clinicians should diagnose posterior semicircular canal BPPV when vertigo associated with torsional, upbeating nystagmus is provoked by the Dix-Hallpike maneuver, performed by bringing the patient from an upright to supine position with the head turned 45 degree to 1 side and neck extended 20 degree with the affected ear down. The maneuver should be repeated with the opposite ear down if the initial maneuver is negative. Strong recommendation

1b. Diagnosis of lateral (horizontal) semicircular canal BPPV

If the patient has a history compatible with BPPV and the DixHallpike test exhibits horizontal or no nystagmus, the clinician should perform, or refer to a clinician who can perform, a supine roll test to assess for lateral semicircular canal BPPV. Recommendation

2a. Differential diagnosis

Clinicians should differentiate, or refer to a clinician who can differentiate, BPPV from other causes of imbalance, dizziness, and vertigo.Recommendation

2b. Modifying factors

Clinicians should assess patients with BPPV for factors that modify management, including impaired mobility or balance,central nervous system disorders, a lack of home support, and/or increased risk for falling. Recommendation

3a. Radiographic testing

Clinicians should not obtain radiographic imaging in a patient who meets diagnostic criteria for BPPV in the absence of additional signs and/or symptoms inconsistent with BPPV that warrant imaging. Recommendation (against)

3b. Vestibular testing

Clinicians should not order vestibular testing in a patient who meets diagnostic criteria for BPPV in the absence of additional vestibular signs and/or symptoms inconsistent with BPPV that warrant testing. Recommendation (against)

4a. Repositioning procedures as initial therapy

Clinicians should treat, or refer to a clinician who can treat, patients with posterior canal BPPV with a canalith repositioning procedure.Strong recommendation

4b. Postprocedural restrictions

Clinicians should not recommend postprocedural postural restrictions after canalith repositioning procedure for posterior canal BPPV. Strong recommendation(against)

4c. Observation as initial therapy
Clinicians may offer observation with follow-up as initial management for patients with BPPV.Option

5. Vestibular rehabilitation

The clinician may offer vestibular rehabilitation, either self administered or with a clinician, in the treatment of BPPV.Option

6. Medical therapy

Clinicians should not routinely treat BPPV with vestibular suppressant medications such as antihistamines and/or benzodiazepines. Recommendation (against)

7a. Outcome assessment

Clinicians should reassess patients within 1 month after an initial period of observation or treatment to document resolution or persistence of symptoms.
Recommendation

7b. Evaluation of treatment failure

Clinicians should evaluate, or refer to a clinician who can evaluate, patients with persistent symptoms for unresolved BPPV and/or underlying peripheral vestibular or central nervous system disorders. Recommendation

8. Education

Clinicians should educate patients regarding the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow-up. Recommendation