Skip to main content

Advertisement

Disability perceived by primary care patients with posterior canal benign paroxysmal positional vertigo

Article metrics

  • 190 Accesses

Abstract

Background

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. Little is known on how posterior canal BPPV affects health-related quality of life in patients diagnosed and treated at primary care facilities or on whether patients with subjective and objective disease perceive the effects differently. This study was designed to describe how patients diagnosed with posterior canal BPPV in primary care perceive disability.

Methods

Cross-sectional descriptive study performed at two urban primary care centers. Participants were patients aged 18 years or older with suspected posterior canal BPPV recruited for baseline evaluation in a clinical trial on the effectiveness of the Epley maneuver in primary care. The recruitment period was from November 2012 to January 2015. Perceived disability was evaluated using the Dizziness Handicap Inventory – Screening version (DHI-S). Other variables collected were age and sex, a history or diagnosis of anxiety or depression, treatment with antidepressants and/or anxiolytics, and results of the Dix-Hallpike (DH) test, which was considered positive when it triggered vertigo with or without nystagmus and negative when it triggered neither.

Results

The DH test was positive in 134 patients, 40.30% of whom had objective BPPV (vertigo with nystagmus). The median age of the patients was 52 years (interquartile range [IQR], 39.00–68.50 years) and 76.1% were women. The median total score on the DHI-S was 16 out of 40 (IQR, 8.00–22.00). Scores were higher (greater perceived disability) in women (p < 0.001) and patients with subjective BPPV (vertigo without nystagmus) (p = 0.033). The items perceived as causing the greatest disability were feeling depressed (67.1%) and worsening of the condition on turning over in bed (88%).

Conclusions

Patients diagnosed with posterior canal BPPV in primary care perceive their condition as a disability according to DHI-S scores, with higher levels of disability reported by women and patients with subjective BPPV. Feelings of depression and turning over in bed were associated with the greatest perceived difficulties.

Trial registration

ClinicalTrials.gov Identifier: NCT01969513. Retrospectively registered. First Posted: October 25, 2013. https://clinicaltrials.gov/ct2/show/NCT01969513

Background

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. It has an annual incidence of between 10.7 and 140 cases per 100,000 inhabitants [1] and a lifetime prevalence of 2.4% [2]. Between 60 and 90% of cases involve the posterior canal [3]. Posterior canal BPPV can be diagnosed in primary care with a targeted history, a basic physical examination, [4]. This test is considered positive when it triggers both vertigo and nystagmus (objective BPPV), although some authors consider that a diagnosis can also be made when it triggers vertigo only (subjective BPPV) [5]. Subjective BPPV accounts for approximately 11.5 to 48% of all cases of BPPV [6]. Studies comparing patients with subjective and objective BPPV have not found differences in terms of demographics or clinical characteristics [7] but little is known on how the two entities affect the quality of life of patients seen in primary care practices.

Patients with BPPV often have physical, functional, and even emotional disabilities that can affect their family or social lives [8]. They are at an increased risk of falls [9], particularly if they are elderly [10], and may also experience psychological symptoms that can affect their daily activities [11]. The resulting distress can have a negative impact on health-related quality of life (HRQOL).

Being exposed to emotional stress increases the odds of getting an episode of Menière’s disease during the following hours in diagnosed patients [12, 13], and anxiety it is also a risk factor for poor prognosis in primary care patients presenting with dizziness [13]. Dizziness can also be brought about by stressful events in the previous year [14], and patients with BPPV have been found to score higher in depression evaluation tests [15].

The impact of BPPV on HRQOL can be assessed using a variety of standardized questionnaires. The most widely used questionnaire is the Dizziness Handicap inventory (DHI) [16]. The original version has 25 items with three possible answers (yes, sometimes, and no) but two shorter versions have been designed: the DHI-SF (short form), which has 13 items each with two possible answers [17], and the DHI-S (screening version), which has 10 items with the same three answers as the original questionnaire [18]. The DHI-S is strongly correlated with the original DHI (r = 0.86) and has high internal consistency (test-retest r = 0.95). It is a self-assessment questionnaire that can be completed in about 4 to 5 min and is therefore suitable for use in settings with large volumes of patients, such as primary care. It has also been validated for use in Spanish [19]. A review comparing the DHI, the DHI-SF, and the DHI-S concluded that the DHI-S was the best scale to use because of its shorter length and close correlation with the original questionnaire [20]. The authors also discouraged the use of domain scores in favor of total score.

Little is known, however, on how BPPV affects HRQOL in patients diagnosed and treated at primary care facilities or on whether patients with subjective and objective disease perceive the effects differently. Moreover, very few studies have used the DHI-S to evaluate self-perceived disability in patients with BPPV, even though it is one of the simplest psychometric tests available [19]. As indicated in the recently updated Clinical Practice Guideline on BPPV, research on the impact of BPPV on HRQOL must continue [1].

The aim of this study was to describe self-perceived disability using the DHI-S in patients with BPPV diagnosed in primary care prior to treatment with the Epley maneuver.

Methods

We performed a cross-sectional descriptive study of two primary care centers with 26 general practitioners (GPs) serving an approximate population of 38,305 people in L’Hospitalet de Llobregat (Barcelona, Spain). The GPs received 2 h of training from an otolaryngologist in the adequate management of patients with vertigo and the correct application and interpretation of the DH test.

Patients aged 18 years or older with a suspected diagnosis of BPPV recruited for a baseline visit within a randomized clinical trial designed to demonstrate the effectiveness of the Epley maneuver for treating posterior canal BPPV in primary care were eligible for inclusion. The protocol of the trial has been published elsewhere. [21]

Patients with a positive DH test were included and those whose results suggested involvement of a portion of the semicircular canal other than the posterior canal or vertigo of central origin were excluded and referred to an otolaryngologist. The rest of the inclusion and exclusion criteria can be consulted in the trial protocol [21] and flow chart (Fig. 1). Nineteen of the patients initially recruited were subsequently excluded because they met the criteria for probable vestibular migraine. This analysis was performed retrospectively in light of increasing evidence on the high prevalence of vestibular migraine and its overlapping symptoms with BPPV [22].

Fig. 1
figure1

Flowchart of the study. DH = Dix-Hallpike

Patients were consecutively recruited by the participating GPs and referred for baseline evaluation within a maximum of 10 days by one of six GPs in the clinical trial team. All patients were being treated with betahistine 8 mg 8- hourly at the initial visit, along with the instruction of P.R.N. use (up to 3 times a day) until improvement of symptoms. The recruitment period was between November 2012 and January 2015.

All the patients had their history taken and underwent a full physical examination and electronic chart review. Disability was assessed using the total DHI-S score as the dependent (outcome) variable. The DHI-S has 10 items that are graded with a score of 0 (for the answer “no”), 2 (“sometimes”), or 4 (“yes”). The minimum score thus is 0 (no disability) while the maximum score is 40 (worst possible self-perceived disability). The independent variables were age, age group (< 65 y vs ≥65 y), sex, DH test result (vertigo only vs vertigo with nystagmus); a previous history of anxiety and/or depression; and treatment with antidepressants or anxiolytics.

The distribution of DHI-S responses was studied by describing the number of yes, no, and sometimes answers to the 10 items for the sample as a whole and stratified by age, sex, presence of nystagmus, and diagnosis of anxiety and/or depression. Total scores were described using medians and interquartile range (IQR) for the full sample and for subgroups stratified by age, sex, nystagmus, and anxiety and/or depression (stratified by sex).

The sample was described using median and IQR for age and absolute and relative frequencies for presence of binary variables and for each of the categories in the categorical variables.

Finally, the Fisher exact test was used to compare the distribution of DHI-S responses according to the study variables. The distribution of total scores by subgroup was compared using the Wilcoxon Rank Sum test. Statistical significance was set at a p value of 0.05 or less.

Results

Of the 330 patients with suspected BPPV, 165 were excluded at the baseline visit (mostly because of a negative DH test) and 19 were excluded retrospectively as they met the criteria for probable vestibular migraine (Fig. 1). We therefore studied 134 patients (40.6%). Of these, 54 (40.30%) had objective BPPV (vertigo with nystagmus).

The median age for the sample was 52 years (IQR, 39.00–68.50) and 76.12% were women. The prevalence of anxiety and depression and the use of benzodiazepines and antidepressants are shown in Table 1.

Table 1 Characteristics of primary care patients with symptoms of benign paroxysmal positional vertigo and a positive Dix-Hallpike test

Table 2 summarizes the responses to the DHI-S. The items for which the fewest patients reported difficulties were item 6 (“Because of your problem, do you restrict your travel for business or holidays?”) and item 9 (“Because of your problem, have you ever been embarrassed in front of others”?), with over 70% of respondents saying they did not experience problems in this area. By contrast, the areas that caused the greatest difficulties were items 5 (Does turning over in bed worsen your problem?) and 1 (Because of your problem, do you feel depressed?), with 74.6% of patients answering “yes” or “sometimes” when asked if turning over in bed increased their problem and 67.1% answering “yes” or “sometimes” when asked if their problem made them feel depressed.

Table 2 Distribution of responses to the Dizziness Handicap Inventory – Screening version for primary care patients with benign paroxysmal positional vertigo

The median DHI-S total score was 16 (IQR, 8.00–22.00) (Table 1). Statistically significant higher scores (greater perceived disability) were detected in women and in patients without nystagmus in the DH test (p < 0.001 and p = 0.033, respectively). No bivariate association was detected for age or for a diagnosis of anxiety or depression stratified by sex with DHI score (Table 3).

Table 3 Total median score on the Dizziness Handicap Inventory – Screening version by subgroups of primary care patients with symptoms of benign paroxysmal positional vertigo

Responses to DHI-S items according to age, sex, objective and subjective BPPV, and a history of anxiety and/or depression are shown in Tables 4 to 7. The distribution of responses was very similar in the two age groups (Table 4). On comparing men and women (Table 5) several significant differences were detected. Women reported significantly greater difficulties in stepping off the sidewalk (p = 0.015), concentrating (p = 0.029), working and fulfilling their household responsibilities (p < 0.001), and leaving their home alone (p = 0.024).

Table 4 Distribution of responses to the Dizziness Handicap Inventory – Screening version for primary care patients with benign paroxysmal positional vertigo according to age group (< 65 vs ≥ 65 y)
Table 5 Distribution of responses to the Dizziness Handicap Inventory – Screening version for 134 primary care patients with benign paroxysmal positional vertigo according to sex
Table 6 Distribution of responses to the Dizziness Handicap Inventory – Screening version for primary care patients with symptoms of benign paroxysmal positional vertigo according to presence of nystagmus
Table 7 Distribution of responses to the Dizziness Handicap Inventory – Screening version for primary care patients with symptoms of benign paroxysmal positional vertigo according to a history of anxiety and/or depression

Patients with subjective BPPV (without nystagmus) reported greater perceived disability in stepping off the sidewalk (p = 0.038), traveling (p = 0.029), and participating in social activities (p = 0.012) (Table 6). No statistically significant differences were observed between patients with and without a history of anxiety and/or depression for responses to the question about feeling depressed (p = 0.217), although the former reported greater disability in relation to work and household responsibilities (p = 0.042) and feelings of embarrassment (p = 0.035) (Table 7).

Discussion

This study shows that disability assessed by the DHI-S is significantly affected by posterior canal BPPV, particularly in women and in patients with subjective disease (vertigo but not nystagmus in the DH test).

The median age of the patients in this series, 52 years, is within the peak range for onset of BPPV (50–70 years) [1] and is also similar to ages described for patients in specialist settings [19, 23]. In primary care settings, median ages of 54.9 [24] and 61 years [25] have been reported.

There were over three times more women than men in our series (female to male ratio, 3.19). Women are often more numerous than men in studies of BPPV [2, 26,27,28], perhaps because the disease is more prevalent in women [2, 29, 30], including those in the 18–34 bracket [31].

Anxiety and depression were common and over 20% of the patients studied were being treated with benzodiazepines and/or antidepressants. These data are consistent with previous reports of high rates of affective disorders, such as anxiety, depression, demoralization, phobia, and somatization, in patients with BPPV [31, 32]. Kahraman et al. [33] recently showed that patients with BPPV may experience intense anxiety and/or panic disorder at the initial visit that may or may not improve with treatment. Attempts to explain why stressful events in the preceding year can trigger BPPV include the hypothesis that the increase in stress-related hormones triggered by the abnormal activation of the hypothalamus–pituitary–adrenal axis could interfere with inner ear blood flow and disrupt the calcium balance in the endolymph, critically affecting otoconial homeostasis [9, 34]. That said, higher depression scores in patients with BPPV have been attributed to the impact of symptoms on patients’ lives [10]. It is therefore perfectly plausible that anxiety and depression are both a cause and consequence of BPPV. In our sample, we found no differences in total scores on the DHI-S between patients with or without a history of anxiety and/or depression, even after adjusting for sex. In brief, thus, a previous diagnosis of anxiety and/or depression was not associated with worse disability results. We did, however, detect a considerable percentage of patients claiming that they felt depressed because of BPPV. Indeed, the fact that over 40% of patients reported that they sometimes felt depressed because of their vertigo adds to the doubts expressed in the recent update of the clinical BPPV guidelines about the adequacy of the term “benign” in benign paroxysmal positional vertigo in reference to the disease’s impact on quality of life, daily activities, and risk of falls [1].

Increased vertigo due to turning over in bed was by far the greatest problem reported by patients in the DHI-S. This is not surprising as this movement is known to trigger or increase episodes of vertigo and has a 90% specificity for the diagnosis of BPPV, although its sensitivity is low [35]. Onset on turning over in bed has also been identified as an independent predictor of BPPV diagnosed with the DH test (odds ratio, 4.36; 95% CI, 1.18–16.13) [36]. The second item with the highest number of “yes” responses was item 1 (“Because of your problem, do you feel depressed?). The median total score on the DHI-S, 16, was slightly lower than scores reported for specialist settings (mean, SD: 19.79 ± 10.,14) [19]; (17.19 ± 9.06) [37] although a similar score has also been reported (16,4 ± 10.71) [20]. It was also lower than the mean scores of 17.72 (SD = 9.98) and 22.67 (12.55) reported for patients with unilateral and bilateral Ménière disease, respectively [26, 38].

Women perceived greater disability as a result of BPPV than men. This finding is consistent with reports by Petri et al. [26] for patients with peripheral unilateral vestibular diseases, including BPPV. We were surprised to see that patients with subjective posterior canal BPPV reported greater levels of perceived disability. This observation, however, should be interpreted with caution because, as mentioned in the introduction, significant differences between patients with subjective and objective BPPV have not been found for demographics, clinical characteristics, or status before and after repositioning procedures [7, 39]. Just one study in Argentina reported higher scores (greater disability) in the physical subscale of the original DHI for patients with nystagmus and in the emotional subscale for patients without nystagmus. There were no significant differences, however, in total scores [40].

The higher proportion of women in our study could be the result of inclusion bias, but it could also reflect the fact that posterior canal BPPV is more common in women and that in Spain, adult women are more likely to visit primary care facilities than men [41].

We acknowledge some limitations of this study. The proportion of patients with subjective BPPV in our series was also higher than that reported in the literature, possibly because neither Frenzel goggles nor videonystagmography were used to detect nystagmus in the DH test to create a more realistic primary care diagnostic environment. However, in mild cases, nystagmus can be difficult to observe, especially given the vertical nystagmus component suppression that can occur in room light. Therefore, the study’s results of greater perceived disability in patients with Subjective-BPPV can be challenged. Given the complexity of interpreting nystagmus during the Dix-Hallpike test, the training received may have been too short. A longer workshop could improve the diagnostic and therapeutic accuracy of GPs, especially to detect and interpret nystagmus correctly in DHT.

Results must be interpreted in light of the descriptive nature of the paper. Significant tests were performed independently with no adjustment for multiple hypotheses testing. In fact, given the large amount of contrasts, significance corrections would have led to only two tests finding statistically significant differences: DHI Total Score and the 7th Item by sex. Studies designed to specifically test each of the “independently significant” contrast would be required to confirm statistical significance.

Conclusions

BPPV had a negative impact on the quality of life of patients, particularly women and patients with subjective disease (vertigo without nystagmus). The greatest perceived difficulties were related to feelings of depression and turning over in bed. The results of this study help to confirm the importance of early diagnosis and effective treatment in patients with BPPV. Both diagnosis and treatment are possible in primary care. More research is needed on how BPPV affects the quality of life of patients attending primary care and on how repositioning maneuvers can help to alleviate these effects. It would also be interesting to explore differences between subjective and objective BPPV, particularly in terms of perceived disability, and to conduct more studies using the shorter, simpler DHI-S scale.

Availability of data and materials

All data generated or analyzed during this study are included in this published article [and its supplementary information files].

Abbreviations

BPPV:

Benign paroxysmal positional vertigo

DH test:

Dix Hallpike test

DHI:

Dizziness Handicap inventory

DHI-S :

Dizziness Handicap inventory screening version

DHI-SF:

Dizziness Handicap inventory short form

GPs:

General practitioners

HRQOL:

Health-related quality of life

ICS:

Catalan Institute of Health

IDIAP:

Institute for Research in Primary Care

IQR:

Interquartile Range

O-BPPV:

Objective benign paroxysmal positional vertigo

PC:

Primary Care

S-BPPV:

Subjective benign paroxysmal positional vertigo

USR:

Research Support Unit

References

  1. 1.

    Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T, et al. Clinical practice guideline: benign paroxysmal positional Vertigo (update) executive summary. Otolaryngol neck Surg off J am Acad Otolaryngol-head neck Surg. 2017;156(3):403–16 Available in: http://www.ncbi.nlm.nih.gov/pubmed/28248602 http://journals.sagepub.com/doi/10.1177/0194599816689660.

  2. 2.

    von Brevern M. Radtke a, Lezius F, Feldmann M, Ziese T, Lempert T, et al. epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry. 2007;78(7):710–5.

  3. 3.

    Kim JS, Oh SY, Lee SH, Kang JH, Kim DU, Jeong SH, et al. Randomized clinical trial for apogeotropic horizontal canal benign paroxysmal positional vertigo. Neurology. 2012;78(3):159–66 Available in: http://www.ncbi.nlm.nih.gov/pubmed/22170885.

  4. 4.

    Dix MR, Hallpike CS.. The pathology symptomatology and diagnosis of certain common disorders of the vestibular system. Proc R Soc Med junio de. 1952;45(6):341–54.

  5. 5.

    Haynes DS, Resser JR, Labadie RF, Girasole CR, Kovach BT, Scheker LE, et al. Treatment of benign positional vertigo using the semont maneuver: efficacy in patients presenting without nystagmus. Laryngoscope. 2002;112(May):796–801.

  6. 6.

    Balatsouras DG, Korres SG. Subjective Benign Paroxysmal Positional Vertigo. Otolaryngol-Head Neck Surg. 2012;146(1):98–103 Available in: http://www.ncbi.nlm.nih.gov/pubmed/21998085 or http://journals.sagepub.com/doi/10.1177/0194599811425158.

  7. 7.

    Jung JY, Kim S-H. Comparison between objective and subjective benign paroxysmal positional vertigo: clinical features and outcomes. Acta Otolaryngol (Stockh). 2016;136(12):1267–72 Available in: https://www.tandfonline.com/doi/full/10.1080/00016489.2016.1203990.

  8. 8.

    Bronstein AM, Golding JF, Gresty MA, Mandala M, Nuti D, Shetye A, et al. The social impact of dizziness in London and Siena. J Neurol. 2010;257(2):183–90.

  9. 9.

    Agrawal Y, Ward BK, Minor LB. Vestibular dysfunction: prevalence, impact, and need for targeted treatment. J Vestib Res. 2013;23(3):113–7.

  10. 10.

    Scherer S, Lisboa HRK, Pasqualotti A. Tontura em idosos: diagnóstico otoneurológico e interferência na qualidade de vida. Rev Soc Bras Fonoaudiol. 2012;17(2):142–50 Available in: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-80342012000200007&lang=pt.

  11. 11.

    Yardley L, Redfern MS. Psychological factors influencing recovery from balance disorders. J Anxiety Disord. 15(1-2):107–19 Available in: http://www.ncbi.nlm.nih.gov/pubmed/11388354.

  12. 12.

    Söderman A-CH, Möller J, Bagger-Sjöbäck D, Bergenius J, Hallqvist J. Stress as a trigger of attacks in Menière’s disease. Laryngoscope. 2004;114(10):1843–8.

  13. 13.

    Dros J, Maarsingh OR, Beem L, Van Der Horst HE, Ter Riet G, Schellevis FG, et al. Functional prognosis of dizziness in older adults in primary care: a prospective cohort study. J Am Geriatr Soc. 2012;60(12):2263–9.

  14. 14.

    Monzani D, Genovese E, Rovatti V, Malagoli ML, Rigatelli M, Guidetti G. Life events and benign paroxysmal positional vertigo: a case-controlled study. Acta Otolaryngol. 2006;126(9):987–92.

  15. 15.

    Nagarkar AN, Gupta AK, Mann SB. Psychological findings in benign paroxysmal positional vertigo and psychogenic vertigo. J Otolaryngol. 2000;29(3):154–8. Available in: http://www.ncbi.nlm.nih.gov/pubmed/10883828.

  16. 16.

    Jacobson GP, Newman CW. The development of the dizziness handicap inventory. Arch Otolaryngol Head Neck Surg. 1990;116:424–7.

  17. 17.

    Tesio L, Alpini D, Cesarani A, Perucca L. Short form of the dizziness handicap inventory. Am J Phys med Rehabil. 1999;78(3):233–41 Available in: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00002060-199905000-00009.

  18. 18.

    Jacobson GP, Calder JH. A screening version of the dizziness handicap inventory (DHI-S). Am J Otol. 1998;19(6):804–8.

  19. 19.

    López-Escámez JA, Gómez Fiñana M, Fernández A, Sánchez Canet I, Palma MJ, Rodríguez J. Evaluation of the treatment of benign paroxysmal positional vertigo with the DHI-S questionnaire. Acta Otorrinolaringol Esp. 2001;52:660–6.

  20. 20.

    Ardıç FN, Tümkaya F, Akdağ B, Şenol H. The subscales and short forms of the dizziness handicap inventory: are they useful for comparison of the patient groups? Disabil Rehabil. 2017;39(20):2119–22.

  21. 21.

    Ballve Moreno JL, Carrillo Muñoz R, Villar Balboa I, Rando Matos Y, Arias Agudelo OL, Vasudeva A, et al. Effectiveness of the Epley’s maneuver performed in primary care to treat posterior canal benign paroxysmal positional vertigo: study protocol for a randomized controlled trial. Trials. 2014, 15(1):179 Available in: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4043960&tool=pmcentrez&rendertype=abstract.

  22. 22.

    Dieterich M, Obermann M, Celebisoy N. Vestibular migraine: the most frequent entity of episodic vertigo. J Neurol. 2016;263(Suppl 1):S82–9.

  23. 23.

    Enloe LJ, Shields RK. Evaluation of health-related quality of life in individuals with vestibular disease using disease-specific and general outcome measures. Phys Ther. 1997;77(9):890–903.

  24. 24.

    Munoz JE, Miklea JT, Howard M, Springate R, Kaczorowski J. Canalith repositioning maneuver for benign paroxysmal positional vertigo randomized controlled trial in family practice. Can Fam Physician. 2007;53(6):1048–53.

  25. 25.

    Hansson EE, Månsson NO, Håkansson A. Balance performance and self-perceived handicap among dizzy patients in primary health care. Scand J Prim Health Care. 2005;23(4):215–20.

  26. 26.

    Petri M, Chirilă M, Bolboacă SD, Cosgarea M. Health-related quality of life and disability in patients with acute unilateral peripheral vestibular disorders. Braz J Otorhinolaryngol. 2016;42:290–3.

  27. 27.

    Obermann M, Bock E, Sabev N, Lehmann N, Weber R, Gerwig M, et al. Long-term outcome of vertigo and dizziness associated disorders following treatment in specialized tertiary care: the dizziness and Vertigo registry (DiVeR) study. J Neurol. 2015;262(9):2083–91.

  28. 28.

    de F RKMOB, de BM FLM, de M FRV, da Silva CN, Deshpande N, Guerra RO. «Positive to Negative» Dix-Hallpike test and Benign Paroxysmal Positional Vertigo recurrence in elderly undergoing Canalith Repositioning Maneuver and Vestibular Rehabilitation. Int Arch Otorhinolaryngol. 2016;20(4):344–52 Available in: http://www.ncbi.nlm.nih.gov/pubmed/27746838 or http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC5063735.

  29. 29.

    Da Silva CN, Ribeiro KMOBDF, Freitas RVDM, Ferreira LMDBM, Guerra RO. Vertiginous symptoms and objective measures of postural balance in elderly people with benign paroxysmal positional Vertigo submitted to the Epley maneuver. Int Arch Otorhinolaryngol. 2014;20(1):61–8.

  30. 30.

    Neuhauser HK, Radtke A, von Brevern M, Lezius F, Feldmann M, Lempert T. Burden of dizziness and vertigo in the community. Arch Intern Med. 2008;168(19):2118–24 Available in: http://www.ncbi.nlm.nih.gov/pubmed/18955641.

  31. 31.

    Kerrigan MA, Costigan MF, Blatt KJ, Mathiason MA, Domroese ME. Prevalence of benign paroxysmal positional vertigo in the young adult population. PM R. 2013;5(9):778–85.

  32. 32.

    Ferrari S, Monzani D, Baraldi S, Simoni E, Prati G, Forghieri M, et al. Vertigo «in the pink»: the impact of female gender on psychiatric-psychosomatic comorbidity in benign paroxysmal positional vertigo patients. Psychosomatics. 2014;55(3):280–8.

  33. 33.

    Kahraman SS, Arli C, Copoglu US, Kokacya MH, Colak S. The evaluation of anxiety and panic agarophobia scores in patients with benign paroxysmal positional vertigo on initial presentation and at the follow-up visit. Acta Otolaryngol. 2017;137(5):485–9.

  34. 34.

    Pérez-Garrigues H, Kuessner D, Benecke H. Patient baseline characteristics in an open-label multinational study of betahistine in recurrent peripheral vestibular vertigo: the OSVaLD study. Curr Med Res Opin. 2007;23(11):2753–61 Available in: http://www.ncbi.nlm.nih.gov/pubmed/17910803.

  35. 35.

    Whitney SL, Marchetti GF, Morris LO. Usefulness of the dizziness handicap inventory in the screening for benign paroxysmal positional vertigo. Otol Neurotol. 2005;26(5):1027–33.

  36. 36.

    Noda K, Ikusaka M, Ohira Y, Takada T, Tsukamoto T. Predictors for benign paroxysmal positional vertigo with positive dix-Hallpike test. Int J gen med. 2011;4:809–14 Available in: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3233377&tool=pmcentrez&rendertype=abstract.

  37. 37.

    Gámiz MJ, Lopez-Escamez JA. Health-related quality of life in patients over sixty years old with benign paroxysmal positional vertigo. Gerontology. 2004;50(2):82–6. Available in: http://www.ncbi.nlm.nih.gov/pubmed/14963374.

  38. 38.

    Lopez-Escamez JA, Viciana D, Garrido-Fernandez P. Impact of bilaterality and headache on health-related quality of life in Meniere’s disease. Ann Otol Rhinol Laryngol. 2009;118(6):409–16.

  39. 39.

    Huebner AC, Lytle SR, Doettl SM, Plyler PN, Thelin JT. Treatment of objective and subjective benign paroxysmal positional Vertigo. J Am Acad Audiol. 2013;24(7):600–6.

  40. 40.

    Gonzalez del Pino B, Perez Fernandez N. Disability in patients with benign paroxysmal positional vertigo with posterior semicircular canal involvement. Acta Otorrinolaringol Esp. 2003;54(6):401–8.

  41. 41.

    Sistema de Información de Atención Primaria (SIAP). Instituto de Información Sanitaria actividad ordinaria en centros de atención primaria. Informe resumen evolutivo del Sistema Nacional de Salud 2007-2009. [Internet]. Ministerio de Sanidad y Política Social. Available in: http://www.msps.es/estadEstudios/estadisticas/docs/siap/Informe_de_Actividad_Ordinaria_Atencion__Primaria__2007-09.pdf

Download references

Acknowledgements

The authors gratefully acknowledge the technical and scientific assistance provided by the Primary Healthcare Research Unit of Costa de Ponent Primary Healthcare University Research Institute IDIAP-Jordi Gol. We also thank Neus Profitós and Celsa Fernández who were responsible for safeguarding the randomization sequence list. Finally, we thank all the participants of the Grupo de estudio del vértigo en atención primaria Florida: José Luis Ballvé Moreno, Yolanda Rando Matos, Estrella Rodero Pérez, Xavier Monteverde Curtó, Carles Rubio Ripollès, Noemí Moreno Farrés, Jean Carlos Gómez Nova, Johan Josué Villarreal Miñano, Diana Lizzeth Pacheco Erazo, Raquel Adroer Martori, Anna Aguilar Margalejo, Olga Lucia Arias Agudelo, Silvia Cañadas Crespo, Laura Illamola Martín, Marta Sarró Maluquer, Lluís Solsona Díaz, Rosa Sorando Alastruey (Equip d’Atenció Primària Florida Nord, Institut Català de la Salut, Hospitalet de Llobregat, Barcelona, Spain), Ricard Carrillo Muñoz, Iván Villar Balboa, Austria Matos Méndez, Marta Bardina Santos (Equip d’Atenció Primària Florida Sud, Institut Català de la Salut, Hospitalet de Llobregat, Barcelona, Spain), Oriol Cunillera Puértolas, Jesús Almeda Ortega Unitat de Suport a la Recerca Costa de Ponent, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Cornellà, Spain. Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain. Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain), Lead author: José Luis Ballvé Moreno E-mail address: ballvejl@gmail.com.

Funding

The project received a research grant from the Carlos III Institute of Health, Ministry of Economy and Competitiveness (Spain), awarded on the 2013 call under the Health Strategy Action 2013–2016, within the National Research Program oriented to Societal Challenges, within the Technical, Scientific and Innovation Research National Plan 2013–2016, with reference PI13/01396, co-funded with European Union ERDF funds (European Regional Development Fund).

It was also funded by the cycle XIV (2013) research grant from the Spanish Primary Care Network (REAP).

The Jordi Gol Institute for Research in Primary care (IDIAP Jordi Gol): Pre-doctoral grant 2014/005E.

The Jordi Gol Institute for research in Primary Care (IDIAP Jordi Gol) contributed financially to the translation of this article into English.

Author information

Conceptualization: JLBM, RCM, IVB, YRM. Formal analysis: JAO, OCP. Funding Acquisition: RCM and JLBM. Investigation: JLBM, RCM, IVB, YRM, ERP, XMC, CRR, NMF, AMM, JCGN, MBS, JJVM, DLPE. Methodology: OCP,JAO. Project Administration: JLBM. Author Contribution: supervisión: CMC, RAL. Writing – Original Draft Preparation: JLBM, RCM, IVB, YRM. Writing – Review & Editing: JLBM, RCM,IVB,YRM, ERP, XMC, CRR, NMF, AMM, JCGN, MBS, JJVM, DLPE, OCP, JAO, AMHS, CMC and RAL. All authors read and approved the final manuscript.

Correspondence to José Luis Ballve Moreno.

Ethics declarations

Ethics approval and consent to participate

The protocol has been approved by the CEIC (Clinical Research Ethics Committee) of IDIAP Jordi Gol, with the number P12/69. The written consent states that the study follows the law contained in the Helsinki Declaration and in Title I, Article 12 of the Royal Spanish Decree 561/1993 from 16 April 1993. Data will be treated according to the organic law that regulates the confidentiality of computerized data (Organic law 5/1992).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Carrillo Muñoz, R., Ballve Moreno, J.L., Villar Balboa, I. et al. Disability perceived by primary care patients with posterior canal benign paroxysmal positional vertigo. BMC Fam Pract 20, 156 (2019) doi:10.1186/s12875-019-1035-3

Download citation

Keywords

  • Benign paroxysmal positional vertigo
  • Primary care
  • Quality of life