Unnecessary diagnostic tests often obtained for benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo prompting patients to seek medical treatment. Diagnosis is made by identifying characteristic nystagmus with positional testing (e.g., Dix-Hallpike maneuver) during a clinical examination. Although diagnosis can be accurately made by non-specialists, costly diagnostic tests are frequently obtained. We examined diagnostic tests ordered and use of specialty consultations in the evaluation of patients eventually diagnosed in our clinic with BPPV.

We retrospectively reviewed the medical records of 193 consecutive adult patients referred to our otoneurology clinic and subsequently diagnosed with isolated BPPV of the posterior canal from 2003 to 2008. In all cases, symptoms resolved after treatment.

One hundred thirty-six patients (71%) underwent at least one test, and no tests were diagnostic. The test most frequently ordered was brain magnetic resonance imaging (n=76), followed by audiogram (n=64), serologic tests (n=42), brain computed tomographic scan (n=32), caloric electronystagmography (n=24), and magnetic resonance angiography (n=23). Internists and otolaryngologists evaluated the same number of patients (n=75) prior to being seen in our clinic, and neurologists saw the next largest group (n=52). Family and emergency physicians evaluated 22 and 16 patients, respectively. The number of diagnostic tests ordered did not significantly vary from 2003 to 2008.

Patients with isolated BPPV undergo many tests of no yield despite the definitive test for diagnosis being a bedside maneuver. Increased use of tests for positional nystagmus likely would improve diagnostic yield and decrease costs in evaluating patients with this common disorder.