Zawroty głowy – Rokowania, prognozy i postęp choroby

Zawroty głowy
Rokowania, prognozy i postęp choroby

Zawroty głowy, najczęściej wynikające z łagodnego napadowego pozycyjnego zawrotu głowy (BPPV), ostrego zapalenia neuronu przedsionkowego oraz choroby Ménière’a, charakteryzują się zróżnicowanym rokowaniem zależnym od etiologii, wieku pacjenta, chorób współistniejących oraz zastosowanego leczenia. W przypadku BPPV około 33% pacjentów doświadcza samoistnej remisji w ciągu 3 tygodni, a większość w ciągu 6 miesięcy, jednak nawroty występują u 5-25% chorych, z wyższym ryzykiem u kobiet, osób starszych i z zaburzeniami psychicznymi. Czynniki prognostyczne wskazujące na potrzebę więcej niż 3 sesji terapeutycznych to podeszły wiek i współistniejący ból szyi, natomiast prowokacja zawrotów w płaszczyźnie poziomej sugeruje krótszą terapię. W zapaleniu neuronu przedsionkowego istotniejsze od funkcji obwodowej są czynniki wzrokowo-przedsionkowe, psychologiczne (lęk) oraz percepcji przedsionkowej, a współistnienie migreny i BPPV znacząco wpływa na niepełnosprawność zarówno w krótkim, jak i długim okresie zdrowienia (r=0,523–0,658, p≤0,003). Audiometria stanowi wartościowe narzędzie prognostyczne, korelując silnie z deficytami przedsionkowymi i umożliwiając bardziej precyzyjną diagnostykę i personalizację leczenia.

Prognoza w Zawrotach Głowy (Vertigo Prognosis)

Rokowanie w Łagodnym Napadowym Pozycyjnym Zawrocie Głowy (BPPV)
Czynniki Prognostyczne w Zawrotach Głowy
Rokowanie w Zapaleniu Neuronu Przedsionkowego
Audiometria jako Narzędzie Prognostyczne
Skala Ryzyka Sudbury dla Przewidywania Poważnych Przyczyn Zawrotów Głowy
Wpływ na Jakość Życia i Rehabilitacja
Cele Leczenia i Oczekiwane Wyniki w BPPV

Znaczenie Wczesnej Diagnostyki dla Rokowania

Rola Badań Obrazowych w Prognozowaniu

Samoistna Poprawa w Zawrotach Głowy

Fizjoterapia w Leczeniu Zawrotów Głowy
Kolejne rozdziały

Prognoza w Zawrotach Głowy (Vertigo Prognosis)

Zawroty głowy stanowią częsty powód wizyt w gabinecie lekarskim, przy czym większość przypadków wynika z łagodnego napadowego pozycyjnego zawrotu głowy (BPPV), ostrego zapalenia neuronu przedsionkowego oraz choroby Ménière’a. Rokowanie w zawrotach głowy jest zróżnicowane i zależy od wielu czynników, w tym etiologii zawrotów, wieku pacjenta, chorób współistniejących oraz wdrożonego leczenia.¹²

Rokowanie w Łagodnym Napadowym Pozycyjnym Zawrocie Głowy (BPPV)

BPPV charakteryzuje się zróżnicowanym przebiegiem naturalnym i reakcją na leczenie. U około jednej trzeciej pacjentów dochodzi do samoistnej remisji objawów w ciągu 3 tygodni, natomiast większość pacjentów osiąga remisję w ciągu 6 miesięcy. Wskaźniki nawrotów są zmienne – niektóre badania wskazują na 18% nawrotów w ciągu 10 lat, inne raportują 15% nawrotów rocznie i 50% nawrotów w ciągu 40 miesięcy po leczeniu.³

Mimo optymalnego leczenia, częstość nawrotów BPPV wynosi od 5 do 25%. Ryzyko nawrotu jest wyższe u kobiet, pacjentów w starszym wieku oraz u osób z współistniejącymi zaburzeniami psychicznymi. Większość pacjentów osiąga ustąpienie objawów w ciągu 4-6 tygodni, choć u niektórych objawy mogą się utrzymywać.⁴

Czynniki Prognostyczne w Zawrotach Głowy

Badania kliniczne zidentyfikowały kilka zmiennych prognostycznych, które mogą pomóc przewidzieć wynik leczenia zawrotów głowy i wcześnie wykryć pacjentów z wysokim lub niskim prawdopodobieństwem sukcesu terapeutycznego.⁵

W przypadku BPPV, zmiennymi, które wskazują na potrzebę więcej niż 3 sesji terapeutycznych, są:

Podeszły wiek⁶⁷
Współistniejący ból szyi⁸

Natomiast prowokacja zawrotów głowy przez ruchy głowy w płaszczyźnie poziomej wskazuje na potrzebę 3 lub mniej sesji terapeutycznych.⁹¹⁰

W przypadku pacjentów bez BPPV, głównym czynnikiem prognostycznym wskazującym na potrzebę więcej niż 4 sesji terapeutycznych jest wiek pacjenta.¹¹

Rokowanie w Zapaleniu Neuronu Przedsionkowego

W zapaleniu neuronu przedsionkowego, długoterminowe rokowanie nie zależy od wielkości rezydualnej funkcji obwodowej mierzonej za pomocą testów kalorycznych czy video head-impulse test. Istotniejszymi czynnikami determinującymi zdrowienie są kombinacja czynników wzrokowo-przedsionkowych (zależność wzrokowa), psychologicznych (lęk) oraz czynników percepcji przedsionkowej.¹²

Badania wykazały, że migrena i BPPV jako choroby współistniejące zaburzają proces zdrowienia po zapaleniu neuronu przedsionkowego. Niepełnosprawność związana z zawrotami głowy w krótkoterminowej fazie zdrowienia była istotnie przewidywana przez:

Migrenę (r=0,523, n=28, p=0,002)¹³
BPPV (r=0,658, n=31, p<0,001)¹⁴
Ostrą zależność wzrokową (r=0,504, n=28, p=0,003)¹⁵

Podobnie, niepełnosprawność w długoterminowej fazie zdrowienia była przewidywana przez te same czynniki, co świadczy o ich istotnym wpływie na rokowanie.¹⁶

Audiometria jako Narzędzie Prognostyczne

Badania wskazują, że ocena audiometryczna może dostarczyć cennych informacji prognostycznych dotyczących dysfunkcji przedsionkowej. Dane pokazują silne powiązanie między utratą słuchu a zawrotami głowy, co sugeruje, że fenotypy audiometryczne mogą stanowić wartościowe narzędzia do precyzowania diagnoz i ułatwiania spersonalizowanego zarządzania pacjentami z zaburzeniami równowagi.¹⁷

Ocena audiometryczna może być wartościowym uzupełnieniem testów oczopląsu przed- i porotacyjnego, zapewniając bardziej kompleksową ocenę funkcji równowagi. Wyniki jednoznacznie wykazują wyraźną korelację między fenotypami audiometrycznymi a deficytami przedsionkowymi, podkreślając znaczenie włączenia oceny słuchu do diagnostycznej ewaluacji osób doświadczających zaburzeń równowagi.¹⁸

Skala Ryzyka Sudbury dla Przewidywania Poważnych Przyczyn Zawrotów Głowy

Skala Ryzyka Sudbury wykorzystuje 7 charakterystyk pacjenta do przewidywania poważnych przyczyn zawrotów głowy, takich jak udar, przemijający atak niedokrwienny, guz mózgu czy rozwarstwienie tętnicy kręgowej.¹⁹

Prawdopodobieństwo poważnej przyczyny waha się od:

0% (wynik <5)²⁰
2,1% dla wyniku 5-8²¹
41% dla wyniku >8²²

Wynik >4 przewiduje poważną diagnozę z czułością 100% i swoistością 72%. Przed wprowadzeniem tej skali do praktyki klinicznej, powinna ona zostać zwalidowana zewnętrznie, a także należy osiągnąć konsensus odnośnie progów punktowych, które wymagają konkretnych działań klinicznych (np. natychmiastowego obrazowania mózgu).²³

Wpływ na Jakość Życia i Rehabilitacja

Prognozy dotyczące zawrotów głowy często nie są optymistyczne pod względem wpływu na jakość życia. Podczas gdy w badaniach obserwowano poprawę na podstawie subiektywnej oceny pacjenta, nie zawsze można to potwierdzić przy zastosowaniu instrumentów mierzących jakość życia.²⁴

Aspekty rehabilitacyjne u pacjentów z zawrotami głowy wydają się być istotne zarówno dla badań, jak i praktycznej implementacji. Szczególnie ważne jest to w kontekście starszych pacjentów, u których zawroty głowy mogą mieć bardziej złożoną etiologię i gorsze rokowanie.²⁵

Cele Leczenia i Oczekiwane Wyniki w BPPV

Głównym celem leczenia BPPV jest ustąpienie objawów związanych z tym schorzeniem. Wśród wtórnych celów można wymienić:²⁶

Zwiększenie dokładności diagnostyki BPPV²⁷
Efektywniejszy powrót do regularnych aktywności i pracy²⁸
Zmniejszenie stosowania nieodpowiednich leków i niepotrzebnych testów diagnostycznych²⁹
Ograniczenie zdarzeń niepożądanych związanych z niezdiagnozowanym lub nieleczonym BPPV³⁰
Minimalizacja kosztów diagnostyki i leczenia BPPV³¹
Ograniczenie potencjalnie niepotrzebnych wizyt kontrolnych³²
Maksymalizacja jakości życia związanej ze zdrowiem u osób dotkniętych BPPV³³

Znaczenie Wczesnej Diagnostyki dla Rokowania

Wczesna i dokładna diagnoza ma kluczowe znaczenie dla rokowania w zawrotach głowy. Znajomość typowych obrazów klinicznych różnych przyczyn zawrotów głowy pomaga w ich rozróżnieniu i odpowiednim ukierunkowaniu diagnostyki.³⁴

Czas trwania każdego epizodu zawrotów głowy ma istotną wartość diagnostyczną – generalnie im dłużej utrzymują się objawy, tym większe prawdopodobieństwo centralnej przyczyny zawrotów głowy. Również nasilenie objawów w czasie dostarcza wartościowych informacji diagnostycznych:³⁵

W ostrym zapaleniu neuronu przedsionkowego początkowe objawy są zazwyczaj nasilone, ale zmniejszają się w ciągu kilku dni³⁶
W chorobie Ménière’a napady zawrotów głowy początkowo nasilają się, a następnie zmniejszają swoje nasilenie³⁷

Obecność fenomenu Tulliusa (oczopląs i zawroty głowy wywołane głośnymi dźwiękami lub dźwiękami o określonej częstotliwości) sugeruje obwodową przyczynę zawrotów głowy. Istotny stres psychospołeczny może również powodować skargi na zawroty głowy.³⁸

Rola Badań Obrazowych w Prognozowaniu

Badania neuroobrazowe mogą być wykorzystywane do wykluczenia rozległych infekcji bakteryjnych, nowotworów lub nieprawidłowości rozwojowych, jeśli inne objawy sugerują jedną z tych diagnoz. Jednak nie są one wskazane u pacjentów z BPPV, zwykle nie są konieczne do zdiagnozowania ostrego zapalenia neuronu przedsionkowego lub choroby Ménière’a i stanowią słabe rutynowe testy przesiewowe w kierunku guzów kąta mostowo-móżdżkowego powodujących zawroty głowy.³⁹

Samoistna Poprawa w Zawrotach Głowy

Wyniki badań wskazują, że samoistne zdrowienie może nadal występować po kilku tygodniach i może przyczyniać się do poprawy klinicznej odnotowanej w kolejnych tygodniach. To ważny czynnik, który należy uwzględnić przy ocenie skuteczności interwencji terapeutycznych i prognozowaniu przebiegu choroby.⁴⁰

Fizjoterapia w Leczeniu Zawrotów Głowy

Ocena kliniczna i leczenie w gabinecie fizjoterapeutycznym mogą stanowić skuteczną i bezpieczną opcję dla pacjentów z zawrotami głowy. Badania zidentyfikowały kilka zmiennych klinicznych o wartości prognostycznej, które mogą pomóc w identyfikacji pacjentów, którzy mogą odnieść korzyść z leczenia lub nie.⁴¹

Wczesne wykrycie pacjentów z wysokim lub niskim prawdopodobieństwem sukcesu leczniczego może skutkować bardziej adekwatnym kierowaniem pacjentów na odpowiednie terapie i wpłynąć pozytywnie na rokowanie.⁴²

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Materiały źródłowe

#1 Initial Evaluation of Vertigo | AAFP
https://www.aafp.org/pubs/afp/issues/2006/0115/p244.html
Benign paroxysmal positional vertigo, acute vestibular neuronitis, and Mnires disease cause most cases of vertigo; however, family physicians must consider other causes including cerebrovascular disease, migraine, psychological disease, perilymphatic fistulas, multiple sclerosis, and intracranial neoplasms. […] Knowing the typical clinical presentations of the various causes of vertigo aids in making this distinction. […] Associated neurologic signs and symptoms, such as nystagmus that does not lessen when the patient focuses, point to central (and often more serious) causes of vertigo, which require further work-up with selected laboratory and radiologic studies such as magnetic resonance imaging. […] Ninety-three percent of primary care patients with vertigo have benign paroxysmal positional vertigo (BPPV), acute vestibular neuronitis, or Mnires disease.
#2 Outcome for dizzy patients in a physiotherapy practice: an observational study
https://pmc.ncbi.nlm.nih.gov/articles/PMC9258437/
Dizziness is a common reason for referral to physiotherapy. Additional information on clinical characteristics, treatment effect and prognostic indicators in physiotherapy practice are needed. […] Clinical evaluation and treatment in physiotherapy practice can be an effective and safe option for patients with dizziness. Several clinical variables with prognostic values were identified. […] Information on prognostic indicators clinical features that predict treatment outcome can help to identify patients who may benefit or not from treatment. The early detection of patients with a high/low chance for treatment success can result in a more adequate referral of patients. […] In BPPV, variables that predicted the need for more than 3 treatments, are age and concomitant neck pain. Provocation of the dizziness by head movements in the horizontal plane predicts the need for 3 or fewer treatments.
#3 Benign Paroxysmal Positional Vertigo – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK470308/
One-third of patients have remission at 3 weeks. The majority of patients remit at 6 months. Recurrence rates are variable in the literature, with 1 study observing an 18% recurrence rate over 10 years. Another study reported a 15% recurrence rate annually and a 50% recurrence at 40 months post-treatment. Under 1% of BPPV cases ever need surgery, but the number of surgical candidates is significant since BPPV is so common. […] BPPV is a very common presentation in primary care. Estimates are that at least 20% of patients complain of vertigo during a clinic visit. Tragically, the condition is often misdiagnosed, and patients are erroneously treated for some other disorder, leading to very high morbidity. Primary care physicians, urgent care providers, and emergency department clinicians must know how to manage this disorder. Once the diagnosis is made and treatment initiated, the prognosis is good. Most people develop symptom resolution in 4 to 6 weeks, although in some patients, the symptoms persist. Despite optimal treatment, there is a 5 to 25% recurrence rate. The risk of recurrence is higher in females, older patients, and those with psychiatric comorbidities.
#4 Benign Paroxysmal Positional Vertigo – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK470308/
One-third of patients have remission at 3 weeks. The majority of patients remit at 6 months. Recurrence rates are variable in the literature, with 1 study observing an 18% recurrence rate over 10 years. Another study reported a 15% recurrence rate annually and a 50% recurrence at 40 months post-treatment. Under 1% of BPPV cases ever need surgery, but the number of surgical candidates is significant since BPPV is so common. […] BPPV is a very common presentation in primary care. Estimates are that at least 20% of patients complain of vertigo during a clinic visit. Tragically, the condition is often misdiagnosed, and patients are erroneously treated for some other disorder, leading to very high morbidity. Primary care physicians, urgent care providers, and emergency department clinicians must know how to manage this disorder. Once the diagnosis is made and treatment initiated, the prognosis is good. Most people develop symptom resolution in 4 to 6 weeks, although in some patients, the symptoms persist. Despite optimal treatment, there is a 5 to 25% recurrence rate. The risk of recurrence is higher in females, older patients, and those with psychiatric comorbidities.
#5 Outcome for dizzy patients in a physiotherapy practice: an observational study
https://pmc.ncbi.nlm.nih.gov/articles/PMC9258437/
Dizziness is a common reason for referral to physiotherapy. Additional information on clinical characteristics, treatment effect and prognostic indicators in physiotherapy practice are needed. […] Clinical evaluation and treatment in physiotherapy practice can be an effective and safe option for patients with dizziness. Several clinical variables with prognostic values were identified. […] Information on prognostic indicators clinical features that predict treatment outcome can help to identify patients who may benefit or not from treatment. The early detection of patients with a high/low chance for treatment success can result in a more adequate referral of patients. […] In BPPV, variables that predicted the need for more than 3 treatments, are age and concomitant neck pain. Provocation of the dizziness by head movements in the horizontal plane predicts the need for 3 or fewer treatments.
#6 Outcome for dizzy patients in a physiotherapy practice: an observational study
https://pmc.ncbi.nlm.nih.gov/articles/PMC9258437/
Dizziness is a common reason for referral to physiotherapy. Additional information on clinical characteristics, treatment effect and prognostic indicators in physiotherapy practice are needed. […] Clinical evaluation and treatment in physiotherapy practice can be an effective and safe option for patients with dizziness. Several clinical variables with prognostic values were identified. […] Information on prognostic indicators clinical features that predict treatment outcome can help to identify patients who may benefit or not from treatment. The early detection of patients with a high/low chance for treatment success can result in a more adequate referral of patients. […] In BPPV, variables that predicted the need for more than 3 treatments, are age and concomitant neck pain. Provocation of the dizziness by head movements in the horizontal plane predicts the need for 3 or fewer treatments.
#7 Outcome for dizzy patients in a physiotherapy practice: an observational study
https://pmc.ncbi.nlm.nih.gov/articles/PMC9258437/
In patients without BPPV, only age predicted the need for more than 4 treatments. […] Our results indicate that spontaneous recovery can still occur after a few weeks, and it can also contribute to the clinical improvement that was recorded in the following weeks. […] We were able to identify several prognostic indicators. Higher age corresponds with a higher number of required treatments in patients with and without BPPV. […] The provocation of the dizziness by movements in the horizontal plane was associated with a lower number of required treatments.
#8 Outcome for dizzy patients in a physiotherapy practice: an observational study
https://pmc.ncbi.nlm.nih.gov/articles/PMC9258437/
Dizziness is a common reason for referral to physiotherapy. Additional information on clinical characteristics, treatment effect and prognostic indicators in physiotherapy practice are needed. […] Clinical evaluation and treatment in physiotherapy practice can be an effective and safe option for patients with dizziness. Several clinical variables with prognostic values were identified. […] Information on prognostic indicators clinical features that predict treatment outcome can help to identify patients who may benefit or not from treatment. The early detection of patients with a high/low chance for treatment success can result in a more adequate referral of patients. […] In BPPV, variables that predicted the need for more than 3 treatments, are age and concomitant neck pain. Provocation of the dizziness by head movements in the horizontal plane predicts the need for 3 or fewer treatments.
#9 Outcome for dizzy patients in a physiotherapy practice: an observational study
https://pmc.ncbi.nlm.nih.gov/articles/PMC9258437/
Dizziness is a common reason for referral to physiotherapy. Additional information on clinical characteristics, treatment effect and prognostic indicators in physiotherapy practice are needed. […] Clinical evaluation and treatment in physiotherapy practice can be an effective and safe option for patients with dizziness. Several clinical variables with prognostic values were identified. […] Information on prognostic indicators clinical features that predict treatment outcome can help to identify patients who may benefit or not from treatment. The early detection of patients with a high/low chance for treatment success can result in a more adequate referral of patients. […] In BPPV, variables that predicted the need for more than 3 treatments, are age and concomitant neck pain. Provocation of the dizziness by head movements in the horizontal plane predicts the need for 3 or fewer treatments.
#10 Outcome for dizzy patients in a physiotherapy practice: an observational study
https://pmc.ncbi.nlm.nih.gov/articles/PMC9258437/
In patients without BPPV, only age predicted the need for more than 4 treatments. […] Our results indicate that spontaneous recovery can still occur after a few weeks, and it can also contribute to the clinical improvement that was recorded in the following weeks. […] We were able to identify several prognostic indicators. Higher age corresponds with a higher number of required treatments in patients with and without BPPV. […] The provocation of the dizziness by movements in the horizontal plane was associated with a lower number of required treatments.
#11 Outcome for dizzy patients in a physiotherapy practice: an observational study
https://pmc.ncbi.nlm.nih.gov/articles/PMC9258437/
In patients without BPPV, only age predicted the need for more than 4 treatments. […] Our results indicate that spontaneous recovery can still occur after a few weeks, and it can also contribute to the clinical improvement that was recorded in the following weeks. […] We were able to identify several prognostic indicators. Higher age corresponds with a higher number of required treatments in patients with and without BPPV. […] The provocation of the dizziness by movements in the horizontal plane was associated with a lower number of required treatments.
#12 Factors influencing clinical outcome in vestibular neuritis â A focussed review and reanalysis of prospective data : WestminsterResearch
https://westminsterresearch.westminster.ac.uk/item/w1644/factors-influencing-clinical-outcome-in-vestibular-neuritis-a-focussed-review-and-reanalysis-of-prospective-data
Following vestibular neuritis (VN), long term prognosis is not dependent on the magnitude of the residual peripheral function as measured with either caloric or the video head-impulse test. Rather, recovery is determined by a combination of visuo-vestibular (visual dependence), psychological (anxiety) and vestibular perceptual factors. […] We found that migraine and BPPV interfere with symptomatic recovery following VN. That is, dizziness handicap at short-term recovery stage was significantly predicted by migraine (r=0.523, n=28, p=.002), BPPV (r=0.658, n=31, p.001) and acute visual dependency (r=0.504, n=28, p=.003). Moreover, dizziness handicap in the long-term recovery stage continued to be predicted by migraine (r=0.640, n=22, p=.001), BPPV (r=0.626, n=24, p=.001) and acute visual dependency (r=0.667, n=22, p.001). […] To summarise, our findings illustrate that in VN, neuro-otological co-morbidities retard recovery, and that measures of the peripheral vestibular system are an aggregate of residual function and cortically mediated gating of vestibular input.
#13 Factors influencing clinical outcome in vestibular neuritis â A focussed review and reanalysis of prospective data : WestminsterResearch
https://westminsterresearch.westminster.ac.uk/item/w1644/factors-influencing-clinical-outcome-in-vestibular-neuritis-a-focussed-review-and-reanalysis-of-prospective-data
Following vestibular neuritis (VN), long term prognosis is not dependent on the magnitude of the residual peripheral function as measured with either caloric or the video head-impulse test. Rather, recovery is determined by a combination of visuo-vestibular (visual dependence), psychological (anxiety) and vestibular perceptual factors. […] We found that migraine and BPPV interfere with symptomatic recovery following VN. That is, dizziness handicap at short-term recovery stage was significantly predicted by migraine (r=0.523, n=28, p=.002), BPPV (r=0.658, n=31, p.001) and acute visual dependency (r=0.504, n=28, p=.003). Moreover, dizziness handicap in the long-term recovery stage continued to be predicted by migraine (r=0.640, n=22, p=.001), BPPV (r=0.626, n=24, p=.001) and acute visual dependency (r=0.667, n=22, p.001). […] To summarise, our findings illustrate that in VN, neuro-otological co-morbidities retard recovery, and that measures of the peripheral vestibular system are an aggregate of residual function and cortically mediated gating of vestibular input.
#14 Factors influencing clinical outcome in vestibular neuritis â A focussed review and reanalysis of prospective data : WestminsterResearch
https://westminsterresearch.westminster.ac.uk/item/w1644/factors-influencing-clinical-outcome-in-vestibular-neuritis-a-focussed-review-and-reanalysis-of-prospective-data
Following vestibular neuritis (VN), long term prognosis is not dependent on the magnitude of the residual peripheral function as measured with either caloric or the video head-impulse test. Rather, recovery is determined by a combination of visuo-vestibular (visual dependence), psychological (anxiety) and vestibular perceptual factors. […] We found that migraine and BPPV interfere with symptomatic recovery following VN. That is, dizziness handicap at short-term recovery stage was significantly predicted by migraine (r=0.523, n=28, p=.002), BPPV (r=0.658, n=31, p.001) and acute visual dependency (r=0.504, n=28, p=.003). Moreover, dizziness handicap in the long-term recovery stage continued to be predicted by migraine (r=0.640, n=22, p=.001), BPPV (r=0.626, n=24, p=.001) and acute visual dependency (r=0.667, n=22, p.001). […] To summarise, our findings illustrate that in VN, neuro-otological co-morbidities retard recovery, and that measures of the peripheral vestibular system are an aggregate of residual function and cortically mediated gating of vestibular input.
#15 Factors influencing clinical outcome in vestibular neuritis â A focussed review and reanalysis of prospective data : WestminsterResearch
https://westminsterresearch.westminster.ac.uk/item/w1644/factors-influencing-clinical-outcome-in-vestibular-neuritis-a-focussed-review-and-reanalysis-of-prospective-data
Following vestibular neuritis (VN), long term prognosis is not dependent on the magnitude of the residual peripheral function as measured with either caloric or the video head-impulse test. Rather, recovery is determined by a combination of visuo-vestibular (visual dependence), psychological (anxiety) and vestibular perceptual factors. […] We found that migraine and BPPV interfere with symptomatic recovery following VN. That is, dizziness handicap at short-term recovery stage was significantly predicted by migraine (r=0.523, n=28, p=.002), BPPV (r=0.658, n=31, p.001) and acute visual dependency (r=0.504, n=28, p=.003). Moreover, dizziness handicap in the long-term recovery stage continued to be predicted by migraine (r=0.640, n=22, p=.001), BPPV (r=0.626, n=24, p=.001) and acute visual dependency (r=0.667, n=22, p.001). […] To summarise, our findings illustrate that in VN, neuro-otological co-morbidities retard recovery, and that measures of the peripheral vestibular system are an aggregate of residual function and cortically mediated gating of vestibular input.
#16 Factors influencing clinical outcome in vestibular neuritis â A focussed review and reanalysis of prospective data : WestminsterResearch
https://westminsterresearch.westminster.ac.uk/item/w1644/factors-influencing-clinical-outcome-in-vestibular-neuritis-a-focussed-review-and-reanalysis-of-prospective-data
Following vestibular neuritis (VN), long term prognosis is not dependent on the magnitude of the residual peripheral function as measured with either caloric or the video head-impulse test. Rather, recovery is determined by a combination of visuo-vestibular (visual dependence), psychological (anxiety) and vestibular perceptual factors. […] We found that migraine and BPPV interfere with symptomatic recovery following VN. That is, dizziness handicap at short-term recovery stage was significantly predicted by migraine (r=0.523, n=28, p=.002), BPPV (r=0.658, n=31, p.001) and acute visual dependency (r=0.504, n=28, p=.003). Moreover, dizziness handicap in the long-term recovery stage continued to be predicted by migraine (r=0.640, n=22, p=.001), BPPV (r=0.626, n=24, p=.001) and acute visual dependency (r=0.667, n=22, p.001). […] To summarise, our findings illustrate that in VN, neuro-otological co-morbidities retard recovery, and that measures of the peripheral vestibular system are an aggregate of residual function and cortically mediated gating of vestibular input.
#17 Audiometry as a predictive proxy for balance dysfunction | Scientific Reports
https://www.nature.com/articles/s41598-025-97995-0
Dizziness and vertigo are common complaints, often linked to inner ear or neurological issues. […] Our findings suggest that audiometric assessments can provide predictive insights into vestibular dysfunction. […] These audiometric phenotypes represent valuable tools for refining diagnoses and facilitating personalized management of patients with balance disorders. […] Our data-driven analysis unveils a strong interplay between hearing loss and dizziness/vertigo. […] Collectively, these findings suggest that audiometric evaluation can serve as a valuable complement to pre- and post-rotatory nystagmus testing, providing a more comprehensive assessment of balance function. […] Our findings unequivocally demonstrate a clear correlation between audiometric phenotypes and vestibular deficits. […] These results underscore the importance of integrating hearing assessment into the diagnostic evaluation of individuals experiencing balance disorders.
#18 Audiometry as a predictive proxy for balance dysfunction | Scientific Reports
https://www.nature.com/articles/s41598-025-97995-0
Dizziness and vertigo are common complaints, often linked to inner ear or neurological issues. […] Our findings suggest that audiometric assessments can provide predictive insights into vestibular dysfunction. […] These audiometric phenotypes represent valuable tools for refining diagnoses and facilitating personalized management of patients with balance disorders. […] Our data-driven analysis unveils a strong interplay between hearing loss and dizziness/vertigo. […] Collectively, these findings suggest that audiometric evaluation can serve as a valuable complement to pre- and post-rotatory nystagmus testing, providing a more comprehensive assessment of balance function. […] Our findings unequivocally demonstrate a clear correlation between audiometric phenotypes and vestibular deficits. […] These results underscore the importance of integrating hearing assessment into the diagnostic evaluation of individuals experiencing balance disorders.
#19 Clinical Risk Score to Predict Serious Causes of Vertigologo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b
https://www.jwatch.org/na58471/2025/02/27/clinical-risk-score-predict-serious-causes-vertigo
The Sudbury Vertigo Risk Score uses 7 patient characteristics to predict serious causes. […] In this study from Canada, researchers derived a new risk score to predict which patients with vertigo are at high risk for a serious cause (i.e., stroke, transient ischemic attack, brain tumor, or vertebral artery dissection). […] The probability of a serious cause ranged from 0% (score, <5), to 2.1% for a score of 5 to 8 and 41% for a score >8. A score of >4 predicted a serious diagnosis with 100% sensitivity and 72% specificity. […] Before the Sudbury Vertigo Risk Score is ready for use in clinical practice, it should be validated externally and consensus must be reached on score thresholds that prompt specific clinical actions (e.g., immediate brain imaging).
#20 Clinical Risk Score to Predict Serious Causes of Vertigologo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b
https://www.jwatch.org/na58471/2025/02/27/clinical-risk-score-predict-serious-causes-vertigo
The Sudbury Vertigo Risk Score uses 7 patient characteristics to predict serious causes. […] In this study from Canada, researchers derived a new risk score to predict which patients with vertigo are at high risk for a serious cause (i.e., stroke, transient ischemic attack, brain tumor, or vertebral artery dissection). […] The probability of a serious cause ranged from 0% (score, <5), to 2.1% for a score of 5 to 8 and 41% for a score >8. A score of >4 predicted a serious diagnosis with 100% sensitivity and 72% specificity. […] Before the Sudbury Vertigo Risk Score is ready for use in clinical practice, it should be validated externally and consensus must be reached on score thresholds that prompt specific clinical actions (e.g., immediate brain imaging).
#21 Clinical Risk Score to Predict Serious Causes of Vertigologo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b
https://www.jwatch.org/na58471/2025/02/27/clinical-risk-score-predict-serious-causes-vertigo
The Sudbury Vertigo Risk Score uses 7 patient characteristics to predict serious causes. […] In this study from Canada, researchers derived a new risk score to predict which patients with vertigo are at high risk for a serious cause (i.e., stroke, transient ischemic attack, brain tumor, or vertebral artery dissection). […] The probability of a serious cause ranged from 0% (score, <5), to 2.1% for a score of 5 to 8 and 41% for a score >8. A score of >4 predicted a serious diagnosis with 100% sensitivity and 72% specificity. […] Before the Sudbury Vertigo Risk Score is ready for use in clinical practice, it should be validated externally and consensus must be reached on score thresholds that prompt specific clinical actions (e.g., immediate brain imaging).
#22 Clinical Risk Score to Predict Serious Causes of Vertigologo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b
https://www.jwatch.org/na58471/2025/02/27/clinical-risk-score-predict-serious-causes-vertigo
The Sudbury Vertigo Risk Score uses 7 patient characteristics to predict serious causes. […] In this study from Canada, researchers derived a new risk score to predict which patients with vertigo are at high risk for a serious cause (i.e., stroke, transient ischemic attack, brain tumor, or vertebral artery dissection). […] The probability of a serious cause ranged from 0% (score, <5), to 2.1% for a score of 5 to 8 and 41% for a score >8. A score of >4 predicted a serious diagnosis with 100% sensitivity and 72% specificity. […] Before the Sudbury Vertigo Risk Score is ready for use in clinical practice, it should be validated externally and consensus must be reached on score thresholds that prompt specific clinical actions (e.g., immediate brain imaging).
#23 Clinical Risk Score to Predict Serious Causes of Vertigologo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b
https://www.jwatch.org/na58471/2025/02/27/clinical-risk-score-predict-serious-causes-vertigo
The Sudbury Vertigo Risk Score uses 7 patient characteristics to predict serious causes. […] In this study from Canada, researchers derived a new risk score to predict which patients with vertigo are at high risk for a serious cause (i.e., stroke, transient ischemic attack, brain tumor, or vertebral artery dissection). […] The probability of a serious cause ranged from 0% (score, <5), to 2.1% for a score of 5 to 8 and 41% for a score >8. A score of >4 predicted a serious diagnosis with 100% sensitivity and 72% specificity. […] Before the Sudbury Vertigo Risk Score is ready for use in clinical practice, it should be validated externally and consensus must be reached on score thresholds that prompt specific clinical actions (e.g., immediate brain imaging).
#24 Prevalence, aetiologies and prognosis of the symptom dizziness in primary care â a systematic review | BMC Primary Care | Full Text
https://bmcprimcare.biomedcentral.com/articles/10.1186/s12875-017-0695-0
Dizziness is a common reason for consulting a general practitioner and there is a broad range of possible underlying aetiologies. […] There exist only few methodologically sound studies concerning aetiology and prognosis of dizziness. […] We could identify only two studies with a low risk of bias. Both looked at older patients with the symptom dizziness and identified cardiovascular disease as main aetiology followed by peripheral vestibular disease. […] Prognostic parameters were assessed in eight studies (two of them with a low risk of bias) using different end-points. […] While in the included studies there could be shown improvement based on subjective patient assessment, this could not be confirmed when applying instruments that measure quality of life. […] Overall, there is a scarcity of studies, which investigate prognosis of dizziness in primary care: Two of the four studies using the DHI include only patients of a minimum age of 65 years. […] As prognosis often is not very good, rehabilitative aspects in patients with dizziness seem to be important for both research and practical implementation.
#25 Prevalence, aetiologies and prognosis of the symptom dizziness in primary care â a systematic review | BMC Primary Care | Full Text
https://bmcprimcare.biomedcentral.com/articles/10.1186/s12875-017-0695-0
Dizziness is a common reason for consulting a general practitioner and there is a broad range of possible underlying aetiologies. […] There exist only few methodologically sound studies concerning aetiology and prognosis of dizziness. […] We could identify only two studies with a low risk of bias. Both looked at older patients with the symptom dizziness and identified cardiovascular disease as main aetiology followed by peripheral vestibular disease. […] Prognostic parameters were assessed in eight studies (two of them with a low risk of bias) using different end-points. […] While in the included studies there could be shown improvement based on subjective patient assessment, this could not be confirmed when applying instruments that measure quality of life. […] Overall, there is a scarcity of studies, which investigate prognosis of dizziness in primary care: Two of the four studies using the DHI include only patients of a minimum age of 65 years. […] As prognosis often is not very good, rehabilitative aspects in patients with dizziness seem to be important for both research and practical implementation.
#26 Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) – American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS)
https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/bppv/
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 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 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-related quality of life of individuals afflicted with BPPV.
#27 Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) – American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS)
https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/bppv/
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 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 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-related quality of life of individuals afflicted with BPPV.
#28 Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) – American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS)
https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/bppv/
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 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 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-related quality of life of individuals afflicted with BPPV.
#29 Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) – American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS)
https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/bppv/
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 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 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-related quality of life of individuals afflicted with BPPV.
#30 Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) – American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS)
https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/bppv/
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 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 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-related quality of life of individuals afflicted with BPPV.
#31 Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) – American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS)
https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/bppv/
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 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 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-related quality of life of individuals afflicted with BPPV.
#32 Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) – American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS)
https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/bppv/
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 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 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-related quality of life of individuals afflicted with BPPV.
#33 Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) – American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS)
https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/bppv/
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 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 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-related quality of life of individuals afflicted with BPPV.
#34 Initial Evaluation of Vertigo | AAFP
https://www.aafp.org/pubs/afp/issues/2006/0115/p244.html
Benign paroxysmal positional vertigo, acute vestibular neuronitis, and Mnires disease cause most cases of vertigo; however, family physicians must consider other causes including cerebrovascular disease, migraine, psychological disease, perilymphatic fistulas, multiple sclerosis, and intracranial neoplasms. […] Knowing the typical clinical presentations of the various causes of vertigo aids in making this distinction. […] Associated neurologic signs and symptoms, such as nystagmus that does not lessen when the patient focuses, point to central (and often more serious) causes of vertigo, which require further work-up with selected laboratory and radiologic studies such as magnetic resonance imaging. […] Ninety-three percent of primary care patients with vertigo have benign paroxysmal positional vertigo (BPPV), acute vestibular neuronitis, or Mnires disease.
#35 Initial Evaluation of Vertigo | AAFP
https://www.aafp.org/pubs/afp/issues/2006/0115/p244.html
The duration of each episode also has significant diagnostic value; generally, the longer symptoms last, the greater the likelihood that there is a central cause of vertigo. […] Knowing the severity of vertigo over time also is helpful. For example, in acute vestibular neuronitis, initial symptoms typically are severe but lessen over the next few days. In Mnires disease, attacks of vertigo initially increase in severity, then lessen in severity later on. […] The presence of Tullios phenomenon (i.e., nystagmus and vertigo caused by loud noises or sounds at a particular frequency) suggests a peripheral cause for vertigo. […] Significant psychosocial stress can cause patients to complain of vertigo. […] Most causes of vertigo with hearing loss are peripheral, the main exception being a cerebrovascular event involving the internal auditory artery or anterior inferior cerebellar artery.
#36 Initial Evaluation of Vertigo | AAFP
https://www.aafp.org/pubs/afp/issues/2006/0115/p244.html
The duration of each episode also has significant diagnostic value; generally, the longer symptoms last, the greater the likelihood that there is a central cause of vertigo. […] Knowing the severity of vertigo over time also is helpful. For example, in acute vestibular neuronitis, initial symptoms typically are severe but lessen over the next few days. In Mnires disease, attacks of vertigo initially increase in severity, then lessen in severity later on. […] The presence of Tullios phenomenon (i.e., nystagmus and vertigo caused by loud noises or sounds at a particular frequency) suggests a peripheral cause for vertigo. […] Significant psychosocial stress can cause patients to complain of vertigo. […] Most causes of vertigo with hearing loss are peripheral, the main exception being a cerebrovascular event involving the internal auditory artery or anterior inferior cerebellar artery.
#37 Initial Evaluation of Vertigo | AAFP
https://www.aafp.org/pubs/afp/issues/2006/0115/p244.html
The duration of each episode also has significant diagnostic value; generally, the longer symptoms last, the greater the likelihood that there is a central cause of vertigo. […] Knowing the severity of vertigo over time also is helpful. For example, in acute vestibular neuronitis, initial symptoms typically are severe but lessen over the next few days. In Mnires disease, attacks of vertigo initially increase in severity, then lessen in severity later on. […] The presence of Tullios phenomenon (i.e., nystagmus and vertigo caused by loud noises or sounds at a particular frequency) suggests a peripheral cause for vertigo. […] Significant psychosocial stress can cause patients to complain of vertigo. […] Most causes of vertigo with hearing loss are peripheral, the main exception being a cerebrovascular event involving the internal auditory artery or anterior inferior cerebellar artery.
#38 Initial Evaluation of Vertigo | AAFP
https://www.aafp.org/pubs/afp/issues/2006/0115/p244.html
The duration of each episode also has significant diagnostic value; generally, the longer symptoms last, the greater the likelihood that there is a central cause of vertigo. […] Knowing the severity of vertigo over time also is helpful. For example, in acute vestibular neuronitis, initial symptoms typically are severe but lessen over the next few days. In Mnires disease, attacks of vertigo initially increase in severity, then lessen in severity later on. […] The presence of Tullios phenomenon (i.e., nystagmus and vertigo caused by loud noises or sounds at a particular frequency) suggests a peripheral cause for vertigo. […] Significant psychosocial stress can cause patients to complain of vertigo. […] Most causes of vertigo with hearing loss are peripheral, the main exception being a cerebrovascular event involving the internal auditory artery or anterior inferior cerebellar artery.
#39 Initial Evaluation of Vertigo | AAFP
https://www.aafp.org/pubs/afp/issues/2006/0115/p244.html
Neuroimaging studies can be used to rule out extensive bacterial infections, neoplasms, or developmental abnormalities if other symptoms suggest one of those diagnoses. […] However, they are not indicated in patients who have BPPV, usually are not necessary to diagnose acute vestibular neuronitis or Mnires disease, and are poor routine screening tests for cerebellopontine angle tumors causing vertigo.
#40 Outcome for dizzy patients in a physiotherapy practice: an observational study
https://pmc.ncbi.nlm.nih.gov/articles/PMC9258437/
In patients without BPPV, only age predicted the need for more than 4 treatments. […] Our results indicate that spontaneous recovery can still occur after a few weeks, and it can also contribute to the clinical improvement that was recorded in the following weeks. […] We were able to identify several prognostic indicators. Higher age corresponds with a higher number of required treatments in patients with and without BPPV. […] The provocation of the dizziness by movements in the horizontal plane was associated with a lower number of required treatments.
#41 Outcome for dizzy patients in a physiotherapy practice: an observational study
https://pmc.ncbi.nlm.nih.gov/articles/PMC9258437/
Dizziness is a common reason for referral to physiotherapy. Additional information on clinical characteristics, treatment effect and prognostic indicators in physiotherapy practice are needed. […] Clinical evaluation and treatment in physiotherapy practice can be an effective and safe option for patients with dizziness. Several clinical variables with prognostic values were identified. […] Information on prognostic indicators clinical features that predict treatment outcome can help to identify patients who may benefit or not from treatment. The early detection of patients with a high/low chance for treatment success can result in a more adequate referral of patients. […] In BPPV, variables that predicted the need for more than 3 treatments, are age and concomitant neck pain. Provocation of the dizziness by head movements in the horizontal plane predicts the need for 3 or fewer treatments.
#42 Outcome for dizzy patients in a physiotherapy practice: an observational study
https://pmc.ncbi.nlm.nih.gov/articles/PMC9258437/
Dizziness is a common reason for referral to physiotherapy. Additional information on clinical characteristics, treatment effect and prognostic indicators in physiotherapy practice are needed. […] Clinical evaluation and treatment in physiotherapy practice can be an effective and safe option for patients with dizziness. Several clinical variables with prognostic values were identified. […] Information on prognostic indicators clinical features that predict treatment outcome can help to identify patients who may benefit or not from treatment. The early detection of patients with a high/low chance for treatment success can result in a more adequate referral of patients. […] In BPPV, variables that predicted the need for more than 3 treatments, are age and concomitant neck pain. Provocation of the dizziness by head movements in the horizontal plane predicts the need for 3 or fewer treatments.