Web-based system shown to be effective in diagnosing, treating vertigo

A web-based system for the diagnosis and treatment of recurrent benign paroxysmal positional vertigo was shown to be effective, researchers reported in JAMA Neurology.

“Dizziness/vertigo is the third most common symptom prompting emergency department visits, accounting for 3.5% to 11% of total emergency department visits, with an annual cost estimated at $3.9 million in the U.S. in 2011,” Hyo-Jung Kim, PhD, of Seoul National University Bundang Hospital, and colleagues wrote.

According to Kim and colleagues, benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo and is found in approximately 17% to 42% of patients with vertigo. BBPV is believed to be caused by dislodged otoconia that enter the semicircular canals, researchers reported.

The canalith repositioning maneuver (CRM) can effectively treat BPPV and results in immediate resolution in 80% of patients, increasing to 92% with repetition, Kim and colleagues wrote.

A previous study from Kim and colleagues found that a six-question questionnaire could diagnose the involved canal and type of BPPV with an accuracy of 71.2%. Of the six questions, the first three screened for BPPV, and the next three determined the BPPV subtype based on the positioning maneuver that induces more intense vertigo, the researchers wrote.

Kim and colleagues conducted a randomized, controlled, parallel-group, double-blind trial to determine efficacy of the web-based program. Of 728 patients with diagnosed and treated BPPV, 585 were enrolled. Patients were monitored for at least 2 years.

Of the 585 patients, 292 were randomized to the treatment group (mean age, 60.3 years; 64% women) and received the questionnaire and a video clip for the self-administration of CRM, based on the subtype of BPPV identified through the questionnaire. The 293 patients in the control group (mean age, 61.1 years; 71% women) received only the video clip for CRM, based on the type of BPPV that had been diagnosed on enrollment.

Overall, 128 patients (21.9%) had recurrence (58 in treatment group vs. 70 in control group) and 109 patients (85.2%) successfully used the web-based system.

In an intention-to-treat analysis, 42 of 58 participants (72.4%) in the treatment group and 30 of 70 participants (42.9%) in the control group reported vertigo resolution (95% CI, 0.13-0.46).

“This trial proved the efficacy of a web-guided self-treatment system for recurrent BPPV,” Kim and colleagues wrote. “Use of this system may play an important role in telemedicine for vestibular disorders.”