Diagnosis and treatment choices of suspected benign paroxysmal positional vertigo: current approach of general practitioners, neurologists, and ENT physicians

  • Agnė UlytėEmail author
  • Domantas Valančius
  • Rytis Masiliūnas
  • Aistė Paškonienė
  • Eugenijus Lesinskas
  • Diego Kaski
  • Dalius Jatužis
  • Kristina Ryliškienė



Benign paroxysmal positional vertigo (BPPV) is a frequently underdiagnosed cause of vertigo, potentially due to the underuse of diagnostic and therapeutic canalith repositioning procedures (CRPs). We aimed to investigate self-reported use of the diagnostic and therapeutic approach to BPPV patients by Lithuanian neurologists, ear, nose, and throat (ENT) physicians, and general practitioners (GPs), and to explore potential reasons for the underuse of the maneuvers.


Neurologists, ENT physicians, and GPs were invited to complete a written questionnaire focused on diagnostic and therapeutic practices related to BPPV. Between-group differences and associations between responses were analyzed statistically.


In total, 97 neurologists, 85 ENT physicians and 142 GPs (21.1%, 26.8%, and 5.7%, respectively, of all corresponding licensed Lithuanian physicians) completed the questionnaire. 24% of neurologists, 33% ENT physicians and 50% GPs do not perform diagnostic maneuvers for patients with suspected BPPV, and 28%, 61%, and 84%, respectively, do not perform CRPs. Years of clinical experience was a negative predictor of CRP performance [OR 0.97 (95% CI 0.95–0.99), p = 0.001]. Frequent reasons for not performing CRPs were time taken for the procedure, fear of provoking symptoms, and lack of knowledge. All physicians frequently ordered additional imaging or consultations for suspected BPPV and reported prescribing a range of medications.


A significant proportion of Lithuanian neurologists, ENT physicians, and GPs do not employ diagnostic maneuvers and CRPs for BPPV patients, contrary to established guidelines. Lack of expertise and time available is a common culprit that leads to unnecessary drug prescribing and investigation.


BPPV Canalith repositioning procedure Epley maneuver Lithuania 



We would like to thank the Lithuanian Institute of Hygiene, Health Information Centre for sharing summary data on vertigo patients’ hospitalizations and diagnoses in Lithuania.


The study received no funding.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interests.

Ethical approval

The study protocol was approved by the local bioethics committee. The study did not involve patient participants and was performed in accordance with the 1964 Helsinki Declaration and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

405_2019_5313_MOESM1_ESM.pdf (79 kb)
Supplementary material 1 (PDF 78 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Epidemiology, Biostatistics and Prevention Institute (EBPI)University of ZurichZurichSwitzerland
  2. 2.Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of MedicineVilnius UniversityVilniusLithuania
  3. 3.Faculty of MedicineVilnius UniversityVilniusLithuania
  4. 4.Clinic of Ear, Nose, Throat, and Eye Diseases, Institute of Clinical Medicine, Faculty of MedicineVilnius UniversityVilniusLithuania
  5. 5.Department of Clinical and Motor NeuroscienceLondonUK

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