Persistent positional perceptual dizziness in clinical practice: a scoping review.

Area of Science:

• Neurotology
• Vestibular Disorders
• Psychosomatic Medicine

Background:

• Dizziness affects 17-30% of the population, with Persistent Positional Perceptual Dizziness (PPPD) being a frequent cause of chronic dizziness.
• PPPD was previously misdiagnosed as psychogenic dizziness.
• PPPD diagnosis relies on specific clinical criteria, often with normal vestibular and imaging tests.

Purpose of the Study:

• To highlight Persistent Positional Perceptual Dizziness (PPPD) as a distinct neurotological entity.
• To outline diagnostic criteria and management strategies for PPPD.
• To emphasize the need for early identification and further research into PPPD.

Main Methods:

• Diagnosis based on Barany society clinical criteria.
• Exclusion of other vestibular disorders.
• Assessment of underlying anxiety traits and triggers like Meniere's disease or vestibular neuritis.

Main Results:

• Vestibular function tests and brain/inner ear imaging are typically normal in PPPD patients.
• Anxiety traits are common, and PPPD often follows acute vertigo episodes.
• Vestibular rehabilitation therapy (VRT), cognitive behavioral therapy (CBT), and SSRIs show promise in treatment.

Conclusions:

• PPPD requires a multimodal management approach, involving otologists and general physicians.
• Differentiating PPPD from bilateral vestibulopathy is crucial.
• Long-term treatment outcomes and the role of biomarkers need further investigation, necessitating standardized guidelines.