A useful telemedicine tool for the diagnosis and treatment of benign paroxysmal positional vertigo. 

Benign paroxysmal positional vertigo (BPPV) is probably the most frequent vestibular disorder. Its annual recurrence rate is approximately 15% to 27%, and 20% of patients experience multiple recurrences. The objective of this randomised, controlled, double-blind trial at hospitals in South Korea was to determine the efficacy of Web-based diagnosis and treatment of BPPV for patients with an initial episode diagnosed and treated in person. After excluding 143 patients for multiple reasons such as not being able to use the internet or spinal cord problems, 292 were randomised to the treatment group and 293 to the control group. At the time of recurrent symptoms of possible BPPV, the treatment group completed an online questionnaire and then followed video instructions to complete the canalith repositioning manoeuvre on the appropriate side. The control group only followed the video to complete the manoeuvre on the side of their initial episode.

Across both groups, 128 (22%) had a BPPV recurrence (58 in the treatment group and 70 in the control group) between July 2017 and February 2022. In the intention-to-treat analysis, the Web-based treatment was successful in 72% of the treatment group and 43% of controls, a significant difference. Most patients overall (85%) could use the Web-based system easily.

Comment: In this well-conducted study, Web-based diagnosis and treatment of BPPV was successful and was certainly helpful for patients during the COVID-19 pandemic. Use of this tool is limited by poor access to and quality of Internet service in many locations worldwide. Education of family doctors and general practitioners is of great importance to improve the diagnosis and treatment of this common condition.

Jaime Toro, MD, Chief, Section of Neurology, Fundación Santa Fe de Bogotá; Professor and Director of the Program of Neurology, University of El Bosque, Santa Fe de Bogotá, Colombia.

Kim HJ, et al. Effect of self-treatment of recurrent benign paroxysmal positional vertigo: a randomized clinical trial. JAMA Neurol 2023; 80: 244-250.

This summary is taken from the following Journal Watch title: Neurology.