{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T19:26:40Z","timestamp":1793215600899,"version":"4.5.0"},"reference-count":294,"publisher":"Wiley","issue":"S3","license":[{"start":{"date-parts":[[2017,3,1]],"date-time":"2017-03-01T00:00:00Z","timestamp":1488326400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2017,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This update of a 2008 guideline from the American Academy of Otolaryngology\u2014Head and Neck Surgery Foundation provides evidence\u2010based recommendations to benign paroxysmal positional vertigo (BPPV), defined as a disorder of the inner ear characterized by repeated episodes of positional vertigo. Changes from the prior guideline include a consumer advocate added to the update group; new evidence from 2 clinical practice guidelines, 20 systematic reviews, and 27 randomized controlled trials; enhanced emphasis on patient education and shared decision making; a new algorithm to clarify action statement relationships; and new and expanded recommendations for the diagnosis and management of BPPV.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The primary purposes of this guideline are to improve the quality of care and outcomes for BPPV by improving the accurate and efficient diagnosis of BPPV, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary testing such as radiographic imaging, and increasing the use of appropriate therapeutic repositioning maneuvers. The guideline is intended for all clinicians who are likely to diagnose and manage patients with BPPV, and it applies to any setting in which BPPV would be identified, monitored, or managed. The target patient for the guideline is aged \u226518 years with a suspected or potential diagnosis of BPPV. The primary outcome considered in this guideline is the resolution of the symptoms associated with BPPV. Secondary outcomes considered include an increased rate of accurate diagnoses of BPPV, a more efficient return to regular activities and work, decreased use of inappropriate medications and unnecessary diagnostic tests, reduction in recurrence of BPPV, and reduction in adverse events associated with undiagnosed or untreated BPPV. Other outcomes considered include minimizing costs in the diagnosis and treatment of BPPV, minimizing potentially unnecessary return physician visits, and maximizing the health\u2010related quality of life of individuals afflicted with BPPV.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Action Statements<\/jats:title>\n                    <jats:p>\n                      The update group made\n                      <jats:italic>strong recommendations<\/jats:italic>\n                      that clinicians should (1) diagnose posterior semicircular canal BPPV when vertigo associated with torsional, upbeating nystagmus is provoked by the Dix\u2010Hallpike maneuver, performed by bringing the patient from an upright to supine position with the head turned 45\u00b0 to one side and neck extended 20\u00b0 with the affected ear down, and (2) treat, or refer to a clinician who can treat, patients with posterior canal BPPV with a canalith repositioning procedure. The update group made a\n                      <jats:italic>strong recommendation against<\/jats:italic>\n                      postprocedural postural restrictions after canalith repositioning procedure for posterior canal BPPV. The update group made\n                      <jats:italic>recommendations<\/jats:italic>\n                      that the clinician should (1) perform, or refer to a clinician who can perform, a supine roll test to assess for lateral semicircular canal BPPV if the patient has a history compatible with BPPV and the Dix\u2010Hallpike test exhibits horizontal or no nystagmus; (2) differentiate, or refer to a clinician who can differentiate, BPPV from other causes of imbalance, dizziness, and vertigo; (3) 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; (4) reassess patients within 1\u00a0month after an initial period of observation or treatment to document resolution or persistence of symptoms; (5) 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; and (6) educate patients regarding the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow\u2010up. The update group made\n                      <jats:italic>recommendations against<\/jats:italic>\n                      (1) radiographic imaging for a patient who meets diagnostic criteria for BPPV in the absence of additional signs and\/or symptoms inconsistent with BPPV that warrant imaging, (2) vestibular testing for a patient who meets diagnostic criteria for BPPV in the absence of additional vestibular signs and\/or symptoms inconsistent with BPPV that warrant testing, and (3) routinely treating BPPV with vestibular suppressant medications such as antihistamines and\/or benzodiazepines. The guideline update group provided the\n                      <jats:italic>options<\/jats:italic>\n                      that clinicians may offer (1) observation with follow\u2010up as initial management for patients with BPPV and (2) vestibular rehabilitation, either self\u2010administered or with a clinician, in the treatment of BPPV.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0194599816689667","type":"journal-article","created":{"date-parts":[[2017,3,1]],"date-time":"2017-03-01T13:31:16Z","timestamp":1488375076000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":503,"title":["Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)"],"prefix":"10.1002","volume":"156","author":[{"given":"Neil","family":"Bhattacharyya","sequence":"first","affiliation":[{"name":"Department of Otolaryngology Harvard Medical School Brigham and Women\u2019s Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel P.","family":"Gubbels","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology School of Medicine and Public Health University of Colorado Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seth R.","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Virginia Mason Medical Center Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan A.","family":"Edlow","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Beth Israel Deaconess Medical Center Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hussam","family":"El\u2010Kashlan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology University of Michigan Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terry","family":"Fife","sequence":"additional","affiliation":[{"name":"Barrow Neurological Institute and College of Medicine University of Arizona Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janene M.","family":"Holmberg","sequence":"additional","affiliation":[{"name":"Intermountain Hearing and Balance Center Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Mahoney","sequence":"additional","affiliation":[{"name":"Vestibular Disorders Association Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deena B.","family":"Hollingsworth","sequence":"additional","affiliation":[{"name":"Ear, Nose &amp; Throat Specialists of Northern Virginia PC Arlington Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Roberts","sequence":"additional","affiliation":[{"name":"Alabama Hearing and Balance Associates, Inc Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D.","family":"Seidman","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery College of Medicine University of Central Florida Orlando Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert W. 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