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Benign paroxysmal positional vertigo in the elderly: current insights

Authors Balatsouras DG, Koukoutsis G, Fassolis A, Moukos A, Apris A

Received 8 April 2018

Accepted for publication 11 July 2018

Published 5 November 2018 Volume 2018:13 Pages 2251—2266


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Richard Walker

DG Balatsouras,1 G Koukoutsis,1 A Fassolis,1 A Moukos,1 A Apris2

1Department of ENT, Tzanion General Hospital of Piraeus, Piraeus, Greece; 2Department of ENT, Nicosia General Hospital, Nicosia, Cyprus

Abstract: Balance disorders, unsteadiness, dizziness and vertigo in the elderly are a significant health problem, needing appropriate treatment. One third of elderly patients with vertigo were diagnosed with benign paroxysmal positional vertigo (BPPV), the most common cause of dizziness in both primary care specialist Neurology and Ear Nose Throat settings. BPPV presents a specific paroxysmal positional nystagmus which can be obtained using the appropriate diagnostic positional test and can be treated effectively using specific therapeutic maneuvers. This review presents current insights into the diagnostic, pathogenetic and therapeutic aspects of BPPV in the elderly. BPPV in older patients does not differ significantly from BPPV in younger patients, with regard to pathogenesis, diagnosis and treatment. However, in older patients, its prevalence is higher and it responds less effectively to treatment, having a tendency for recurrence. Specific issues which should be considered in the elderly are: 1) difficulty in obtaining an accurate history; 2) difficulty in performing the diagnostic and therapeutic maneuvers, which should be executed with slow and gentle movements and extremely cautiously to avoid any vascular or orthopedic complications; and 3) the relation between BPPV and falls.

Keywords: dizziness, vestibular, benign paroxysmal positional vertigo, balance, elderly

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