Diagnosis Of Benign Paroxysmal Positional Vertigo Research Articles

Anxiety characteristics in benign paroxysmal positional vertigo: first vs. recurrent episodes

PurposeTo assess the difference in state and trait anxiety levels in patients with Benign Paroxysmal Positional Vertigo (BPPV) at the first episode (FE) versus recurrent episodes (RE), before and after vestibular physiotherapy. A secondary objective was to assess the difference in the prevalence of underlying health conditions between FE and RE BPPV patients.MethodsFifty-five patients with BPPV, aged 40–70, were recruited. The diagnosis of BPPV was confirmed based on subjective complaints of vertigo and positive results from the Dix–Hallpike and Supine Roll tests. Twenty-four patients were in their FE, and 31 had RE. All patients completed the State–Trait Anxiety Inventory (STAI) questionnaire three times; before, immediately after, and a week after vestibular physiotherapy treatment.ResultsThe RE group demonstrated higher trait anxiety than the FE group in all testing points: before treatment (median value of 38 versus 29, p-value = 0.02), immediately after treatment (median value of 36 versus 28, p-value < 0.01) and a week later (median value of 38 versus 28, p-value < 0.01). State anxiety decreased immediately after treatment in both groups, but at the second session, it was significantly higher in the RE than in the FE group (median value of 38 versus 28.5, p-value = 0.03). Hypothyroidism was significantly more frequent in the RE group (RE 16%, FE 0%, p-value = 0.04).ConclusionsBased on the current study’s findings, we recommend assessing anxiety levels in patients with recurrent BPPV and consider referring them for appropriate treatment when necessary.

Turkish validity and reliability study of the benign paroxysmal positional vertigo diagnostic scale

Objectives: The study aimed to evaluate the Turkish validity and reliability of the benign paroxysmal positional vertigo (BPPV) diagnostic scale. Patients and Methods: One hundred seventeen patients (67 females, 50 males; mean age: 49.3±12.3 years; range 18 to 74 years) over the age of 18 who were diagnosed or suspected of BPPV, Meniere's disease, vestibular neuritis, or other peripheral vestibular disease were included. Participants filled out the BPPV diagnostic scale. The affected canal and the ear side were determined by performing positional maneuvers to confirm the diagnosis of BPPV. The final version of the scale was created by performing language and content validity, construct validity, reliability, and test-retest analyses of the BPPV diagnostic scale in the given order. Results: Of the 117 patients, 70 were diagnosed with BPPV, 26 with Meniere’s disease, 16 with vestibular neuritis, and five participants with other peripheral vestibular disease. Kendal W for content validity was 0.060 (p=0.700&gt;0.05), and expert opinions showed good agreement. The factor load of the BPPV diagnostic scale was found within the normal range (0.364 to 0.807). Goodness of fit index values were obtained above 0.90. According to this result, the model fit well. The internal consistency Cronbach's alpha (a) coefficient of the scale was 0.716. This value showed that the scale had good reliability. According to the results of the scale, a statistically significant difference was found between the responses of the BPPV group and the other diagnostic groups (p&lt;0.05). Conclusion: The Turkish version of the BPPV diagnostic scale was found to be valid and reliable. This scale is useful in detecting BPPV and establishing the differential diagnosis. The use of the scale is thought to be beneficial in patients with suspected BPPV but who have difficulties in diagnosis and to support objective tests.

Diagnosis and treatment of benign paroxysmal positional vertigo with manual and motorized chairs - Indication and value

Benign paroxysmal positional vertigo (BPPV) is the most frequent cause of episodic vertigo or dizziness. While this diagnosis can be made reliably in most cases by use of targeted history taking followed by provocation maneuvers on the examination couch and subsequent repositioning maneuver, these maneuvers may not be applicable in a subgroup of patients with pre-existing conditions such as musculoskeletal or neurologic disorders. At the same time, part of patients treated on the examination couch will not respond to the repositioning maneuvers. The use of a manual or motorized turntable thus extends both the diagnostic and therapeutic options in BPPV. Thus, it enables patients with disabilities that do not tolerate classic maneuvers on the examination couch access to the required diagnostic procedures and - if needed - provides targeted treatment as well. Furthermore, turntables extend both the diagnostic and the therapeutic spectrum, offering a broader range of repositioning maneuvers in unclear or treatment-refractory cases. In this narrative review potential indications are described and evidence for using turntables in the diagnosis and treatment of BPPV on the turntable is discussed.

Canal Conversion and Reentry of Otolith in Benign Paroxysmal Positional Vertigo

During the treatment process for benign paroxysmal positional vertigo (BPPV) using the canalith repositioning procedure, the otolith can inadvertently enter the semicircular canal instead of the utricle. Canal conversion refers to the situation where the otolith enters a different semicircular canal, while reentry occurs when the otolith returns to the same semicircular canal. The occurrence of a canal conversion can complicate the accurate diagnosis and treatment of BPPV, potentially leading to misdiagnosis and unsuccessful results in the canalith repositioning procedure. In this review, we aim to summarize the incidence, clinical features, and associated risk factors of canal conversion and reentries.

Otolin-1 as a biomarker for the evaluation of the effectiveness of betahistine treatment for benign paroxysmal positional vertigo

Objective Benign paroxysmal positional vertigo (BPPV) is the most common vertigo disorder. Betahistine is the most commonly used drug in the treatment of vertigo, however its effect on the inner ear is not fully known. Otolin-1 is an inner ear-specific glycoprotein that can be identified in peripheral blood. The aim of the study was to determine the effect of treatment of betahistine for BPPV on serum otolin-1 levels. Methods Thirty (30) patients with BPPV and 30 healthy controls were enrolled in the study. Serum otolin-1 levels were measured before and 14 days after perioral (po) betahistine treatment in the BPPV group, whereas otolin-1 level was examined once in controls. The efficacy of treatment was evaluated with Dizziness Handicap Index (DHI) and Visual Analog Scale (VAS) in the BPPV group. Results Otolin-1 levels were statistically significantly higher in patients with BPPV than controls. In the BPPV group, serum otolin-1 level was found to be statistically significantly lower after betahistine treatment. There was a statistically significantly difference between pre-treatment and posttreatment groups regarding to both DHI and VAS scores. Conclusion Serum otolin-1 can be used as a biomarker in monitoring the effectiveness of treatment of BPPV with betahistine as well as diagnosis of BPPV.

Comparative Efficacy of Epley, Semont and Gans Maneuver in Treating Posterior Canal Benign Paroxysmal Positional Vertigo.

Pharmacological therapies are used to control Benign paroxysmal positional vertigo (BPPV) symptoms for a brief period, discontinuing them usually results in recurrence. Canalolith repositioning maneuvers, including Epley, Semont, and Gans maneuvers, have been recommended for treating posterior canalBPPV with a high rate of success. A prospective, quasi-randomized study was carried out to compare the efficacy of Epley, Semont, and Gans maneuvers in the treatment of posterior canal BPPV and their durability. All patients over the age of 20 who met the BPPV diagnostic criteria, regardless of gender, were included in the study. Diagnosis of BPPV was done by Dix Hallpike maneuver. Typical posterior canal BPPV, the most frequent form of BPPV, is characterized by paroxysmal nystagmus evoked through the Dix-Hallpike test; the nystagmus is torsional clockwise for the left side, counter-clockwise for the right side, with a vertical up-beating component. The patients were uniformly quasi-randomized in a 1:1:1 ratio to be treated with Epley, Semont, and Gans maneuvers. After performing the maneuver, the patients were again subjected to the Dix-Hallpike test. Based on the result of the Dix-Hallpike test's positivity, the maneuvers were repeated up to three times. All the patients were called for a reassessment 30days after the last intervention to assess the durability of the maneuver. In the study, 54.44% (49) of the 90 patients were female, whereas 45.56% (41) were male. Overall, 83.33% (75) of patients required only one attempt, 15.56% (14) required two attempts, and 1.11% (1) required three attempts to improve. In the Epley maneuvers group, 86.66% (26) required only one attempt, 10% (3) required two attempts, and 3.33% (1) required three attempts. Similarly, 83.33% (25) required only one attempt in the Gans maneuvers group, and 16.67% (5) required two attempts. In Semont maneuver groups, 80% (24) required only one attempt, and 20% (6) required two attempts. The recurrence of the symptoms was seen in a total of 11 patients: 27.27% (3 patients) of the Epley maneuvers group, 36.36% (4 patients) of the Gans maneuvers group, and 36.36% (4 patients) of the Semont maneuvers group. All three maneuvers show equal efficacy in reducing vertigo. The Epley maneuver may be more relevant in the treatment of BPPV compared to others, considering the slightly higher improvement rate and the requirement for fewer attempts for the treatment.

A nystagmus extraction system using artificial intelligence for video-nystagmography

Benign paroxysmal positional vertigo (BPPV), the most common vestibular disorder, is diagnosed by an examiner changing the posture of the examinee and inducing nystagmus. Among the diagnostic methods used to observe nystagmus, video-nystagmography has been widely used recently because it is non-invasive. A specialist with professional knowledge and training in vertigo diagnosis is needed to diagnose BPPV accurately, but the ratio of vertigo patients to specialists is too high, thus necessitating the need for automated diagnosis of BPPV. In this paper, a convolutional neural network-based nystagmus extraction system, ANyEye, optimized for video-nystagmography data is proposed. A pupil was segmented to track the exact pupil trajectory from real-world data obtained during field inspection. A deep convolutional neural network model was trained with the new video-nystagmography dataset for the pupil segmentation task, and a compensation algorithm was designed to correct pupil position. In addition, a slippage detection algorithm based on moving averages was designed to eliminate the motion artifacts induced by goggle slippage. ANyEye outperformed other eye-tracking methods including learning and non-learning-based algorithms with five-pixel error detection rate of 91.26%.

A cross-sectional methodological study: evaluation of the examiner performance on the Dix-Hallpike test

Purpose The Dix-Hallpike test is recommended to diagnose Benign Paroxysmal Positional Vertigo (BPPV). This research aimed to quantify the movement of a healthy subject during the Dix-Hallpike test and determine what factors contribute to performance variation from the recommended head position with 20° cervical extension, 45° cervical rotation, and a brisk movement velocity. Materials and methods Examiners performed the Dix-Hallpike test 10 times. The examinee’s movement was recorded with Qualisys and processed with Visual3D. The proportion of variation in test performance within examiners, between examiners, and due to examiner position was calculated. Results Thirteen participants, 54% male and mean age 40, performed 50 cranial and 77 lateral Dix-Hallpike tests. Head position differed significantly from the recommendations with the cranial tests for extension (mean difference [MD] = 11.6°, p < 0.001) and rotation (MD = 4.8°, p < 0.001) and with lateral tests for extension (MD = 13.3°, p < 0.001). The largest proportion of variation was between examiners (60–91%), followed by within-examiners (3–16%). The examiner position contributed to 20% of the variation in the cervical rotation achieved. Tests lasted, on average, 1.80 s. Conclusions Differences within and between examiners visually estimating the Dix-Hallpike test endpoints may impede BPPV diagnosis accuracy.

The reliability of a subtype-determining questionnaire in efficient benign paroxysmal positional vertigo diagnosis in geriatrics.

Benign paroxysmal positional vertigo (BPPV), the most common cause of dizziness, especially for older adults, exposes patients to the lethal risk of falling. However, the diagnosis of BPPV in this population can be more elusive as they present few characteristic symptoms. Therefore, we explored the application of a subtype-determining questionnaire in BPPV diagnosis among the geriatric population. Patients were assigned to the aware and unaware groups. In the aware group, the technician would directly test the suspected canal indicated by the questionnaire, whereas, in the unaware group, the technician performed the regular positional test. The diagnostic parameters of the questionnaire were examined. The accuracy, sensitivity, and specificity of questions 1-3 for diagnosing BPPV were 75.8, 77.6, and 74.7%, respectively. Question 4 demonstrated an accuracy of 75.6% in ascertaining the BPPV subtype, question 5 showed an accuracy of 75.6% in determining the affected side, and question 6 yielded an accuracy of 87.5% in distinguishing canalithiasis or cupulolithiasis. Examination time was shorter in the aware group than that in the unaware group (P < 0.05). No difference was found between the two groups for treatment time (P = 0.153). This subtype-determining questionnaire is practical in daily use and capable of providing instructive information for an efficient diagnosis in geriatric patients with BPPV.

Torsional nystagmus recognition based on deep learning for vertigo diagnosis.

Detection of torsional nystagmus can help identify the canal of origin in benign paroxysmal positional vertigo (BPPV). Most currently available pupil trackers do not detect torsional nystagmus. In view of this, a new deep learning network model was designed for the determination of torsional nystagmus. The data set comes from the Eye, Ear, Nose and Throat (Eye&ENT) Hospital of Fudan University. In the process of data acquisition, the infrared videos were obtained from eye movement recorder. The dataset contains 24521 nystagmus videos. All torsion nystagmus videos were annotated by the ophthalmologist of the hospital. 80% of the data set was used to train the model, and 20% was used to test. Experiments indicate that the designed method can effectively identify torsional nystagmus. Compared with other methods, it has high recognition accuracy. It can realize the automatic recognition of torsional nystagmus and provides support for the posterior and anterior canal BPPV diagnosis. Our present work complements existing methods of 2D nystagmus analysis and could improve the diagnostic capabilities of VNG in multiple vestibular disorders. To automatically pick BPV requires detection of nystagmus in all 3 planes and identification of a paroxysm. This is the next research work to be carried out.

EFFECTIVENESS OF EPLEY’S MANEUVER IN POSTERIOR CANAL BENIGN PAROXYSMAL POSITIONAL VERTIGO: A PROSPECTIVE OBSERVATIONAL STUDY

Objectives: The aim of the present study was to determine the effectiveness of Epley’s maneuver in curing posterior canal benign paroxysmal positional vertigo (BPPV). Methods: This was a single-center, hospital-based, prospective observational study involving a total of 51 patients diagnosed with BPPV. The diagnosis of BPPV was confirmed by Dix–Hallpike’s maneuver (DHM). The patients of BPPV were treated using Epley’s maneuver. The patients were followed on the 4th, 10th, 30th, and 180th days after the initial consultation. The response to DHM was recorded on each follow-up visit. Results: Among the enrolled 51 participants, 47 did not have any complaints related to giddiness post treatment. Thus, the effectiveness of Epley’s maneuver in treating posterior semicircular canal BPPV at 6 months was 92.16%. Overall, 5 participants (10.6%) who were cured on the first follow-up visit had a recurrence of BPPV at the 1-month follow-up visit. As the duration of follow-up increased, the quality-of-life score decreased, indicating that patients felt better or relieved from symptoms with time. On the follow-up visits on day 4, day 10, 1 month, and 6 months after Epley’s maneuver, it was 43.1%, 72.5%, 88.2%, and 92.2%, respectively, for those who had a negative response to DHM. Conclusion: Epley’s maneuver is an effective treatment modality for patients diagnosed with posterior semicircular canal BPPV and shows a significant improvement in quality of life for such patients with low recurrence rates.

Adoption of clinical practice guidelines in cases of benign paroxysmal positional vertigo.

Despite being one of the most common types of the peripheral vertigo encountered in clinical practice, benign paroxysmal positional vertigo (BPPV) remains underdiagnosed and undertreated, even in affluent health care systems. The publication of fully updated clinical practice guidelines significantly facilitated the diagnosis and treatment of BPPV. This study evaluates the adoption of the guidelines in our clinical setting and reviews further recommendations for quality-of-care improvement. This retrospective cross-sectional survey included a total of 1155 adult patients diagnosed with BPPV at the biggest tertiary care center in the country during a 5-year period (2017-2021). The data for the first three years (2017-2020) and 919 patients were collected in full, and for the remaining 236 patients (2020-2021) only partially due to the disturbance in referrals caused by COVID-19 pandemic. The familiarity with and adherence to the published clinical guidelines by physicians judged by patients' charts and our health care database were overall unsatisfactory. The adherence varied from 0 to 40.5% in our sample. The recommendations for making the diagnosis and for repositioning procedure as first-line therapy were followed in only 20-30% of cases. There are large opportunities for improvement in quality of care of BPPV patients. Apart from constant and systematic education at the primary health care level, the health care system may need to adopt more advanced measures of ensuring better adherence to guidelines and subsequent reduction in medical costs.

Diagnosing the benign paroxysmal positional vertigo via 1D and deep-learning composite model.

Benign Paroxysmal Positional Vertigo (BPPV) is the leading cause of vertigo, and its characteristic nystagmus induced by positional maneuvers makes it a good model for Artificial Intelligence (AI) diagnosis. However, during the testing procedure, up to 10min of indivisible long-range temporal correlation data are produced, making the AI-informed real-time diagnosing unlikely in clinical practice. A combined 1D and Deep-Learning (DL) composite model was proposed. Two separate cohorts were recruited, with one for model generation and the other for evaluation of model's real-world generalizability. Eight features, including two head traces and three eye traces and their corresponding slow phase velocity (SPV) value, were served as the inputs. Three candidate models were tested, and a sensitivity study was conducted to determine the saliently important features. The study included 2671 patients in the training cohort and 703 in the test cohort. A hybrid DL model achieved a micro-area under the receiver operating curve (AUROC) of 0.982 (95% CI 0.965, 0.994) and macro-AUROC of 0.965 (95% CI 0.898, 0.999) for overall classification. The highest accuracy was observed for right posterior BPPV, with an AUROC of 0.991 (95% CI 0.972, 1.000), followed by left posterior BPPV, with an AUROC of 0.979 (95% CI 0.940, 0.998), the lowest AUROC was 0.928 (95% CI 0.878, 0.966) for lateral BPPV. The SPV was consistently identified as the most predictive feature in the models. If the model process is carried out 100 times for a 10-min data, one single running takes 0.79 ± 0.06s. This study designed DL models which can accurately detect and categorize the subtype of BPPV, enabling a quick and straightforward diagnosis of BPPV in clinical setting. The critical feature identified in the model helps expand our understanding of this disorder.

Analysis of patient variables including socioeconomic indicators and their association with recurrence rates and persistence of benign paroxysmal positional vertigo: A retrospective case series.

Analysis of patient variables including socioeconomic indicators and their association with recurrence rates and persistence of benign paroxysmal positional vertigo: A retrospective case series.

Guideline Adherence to Benign Paroxysmal Positional Vertigo Treatment and Management in Primary Care.

To determine adherence to the 2017 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines for the management and treatment of benign paroxysmal positional vertigo (BPPV) in primary care (PC) and compare whether key recommendations differed by sex, race, or insurance status. Retrospective chart review. Twenty-six clinic locations within a single healthcare system. Charts of 458 patients diagnosed with BPPV in PC between 2018 and 2022 were reviewed. Encounters where the diagnosis of BPPV was made were identified. From the clinical encounter note, demographics, symptomatology, management, and treatment were extracted. Nonparametric analyses were used to identify whether AAO-HNS guidelines differed regarding sex, race, or insurance status. Of 458 patients, 249 (54.4%) did not receive a diagnostic exam, and only 4 (0.9%) patients received imaging. Regarding treatment, only 51 (11.1%) received the Epley maneuver, with 263 (57.4%) receiving vestibular suppressant medication and 12.4% receiving a referral to a specialist. In regard to sex, race, or insurance status, there was no significant difference in receiving a Dix-Hallpike diagnostic maneuver, Epley maneuver, vestibular suppressant medication, imaging, or referral to a specialist. Our data suggestthat there continue to be gaps in the adherence to AAO-HNS guidelines; however, these gaps did not differ by sex, race, or insurance status. Care should be taken to increase the use of diagnostic and treatment maneuvers but decrease the use of vestibular-suppressant medications for the treatment of BPPV in PC.

Benign Paroxysmal Positional Vertigo Is Associated with an Increased Risk for Migraine Diagnosis: A Nationwide Population-Based Cohort Study.

Previous studies reported an increased risk of benign paroxysmal positional vertigo (BPPV) in patients with migraine. Hence, we aimed to assess the risk of migraine in patients with BPPV. This cohort study was conducted using the Taiwan National Health Insurance Research Database. The BPPV cohort consisted of patients aged <45 years with a diagnosis of BPPV between 2000 and 2009. An age- and sex-matched comparison group free from a history of BPPV or migraine was selected. All cases were followed up from 1 January 2000 to 31 December 2010 or until death or a diagnosis of migraine. The baseline demographic characteristics in both groups were compared using Student's t-test and the chi-square test. Cox proportional hazards regression analysis was used to estimate the hazard ratio for migraine in the BPPV cohort compared with the comparison group after adjustment for age, sex, and comorbidities. Notably, 117 of the 1386 participants with BPPV and 146 of the 5544 participants without BPPV developed migraine. After adjustment for age, sex, and comorbidities, BPPV showed an adjusted hazard ratio indicating a 2.96-fold increased risk of migraine (95% confidence interval: 2.30-3.80, p < 0.001). We found that BPPV is associated with an increased risk of a migraine diagnosis.

Significance of subtype-determining questionnaire in efficient diagnosis and treatment of BPPV

Background Rapid recognition of benign paroxysmal positional vertigo (BPPV) matters in many ways, questionnaires evolve as a new alternative for diagnosis. A subtype-determining questionnaire is a more advanced but rarely studied type. Objective To explore the practicability of a subtype-determining questionnaire in facilitating diagnosis and treatment of BPPV. Methods A BPPV subtype-determining questionnaire was applied to vertiginous patients. All patients underwent the positional test, performed by one technician, who was either informed or uninformed about questionnaire results randomly. In the informed group, the technician checked the canal indicated by the questionnaire straightforwardly; in the uninformed group, she performed the conventional positional test. Diagnostic parameters of the questionnaire and disparities between the 2 groups were investigated. Results The accuracy, sensitivity, specificity of question 1–3 for diagnosing BPPV is 74.4%, 90.9%, 66.6% respectively. Question 4 shows an accuracy of 80.7% in determining BPPV subtype, question 5 yields an accuracy of 78.7% in ascertaining the affected side, question 6 exhibits an accuracy of 87.2% in deciding canalithiasis or cupulolithiasis. Both examination and treatment time were shorter in the informed group (p < .05). Conclusion This subtype-determining questionnaire has appealing diagnostic ability. It provides valuable information that’s conducive to fast diagnosis and efficient treatment of BPPV.

Recurrent benign paroxysmal positional vertigo in two DFNB16 siblings: A CARE case report

IntroductionDeletions or variants of the STRC gene coding for stereocilin cause congenital bilateral mild-to-moderate sensorineural hearing loss without vestibular disorder: DFNB16. Stereocilin is a protein present in vestibular kinocilia embedded in the otoconial membrane of the utricular macula. Benign paroxysmal positional vertigo (BPPV) is a rare form of vertigo in children. The present study reports recurrent positional vertigo in two DFNB16 siblings. ObservationTwo patients, 10 and 15 years old, presented with recurrent disabling positional vertigo episodes, triggered by turning over in bed, with a falling sensation. The diagnosis of right posterior canal BPPV was confirmed on Dix-Hallpike maneuvers in one of the patients. Variations in the response of ocular vestibular-evoked myogenic potentials were observed. Probable BPPV was diagnosed in the second patient. Their other two siblings did not have hearing loss or vertigo. ConclusionThe absence of stereocilin due to homozygous deletions of the STRC gene in DFNB16 patients can cause vestibular dysfunction, including BPPV.

Management of benign paroxysmal positional vertigo (BPPV) post head injury: Case Study from the emergency department

BACKGROUND: Head trauma can cause secondary benign paroxysmal positional vertigo (BPPV). BPPV is a common peripheral condition which can lead to significant morbidity, psychosocial impact and increased medical costs [1]. CASE DESCRIPTION: A patient post fall with an associated head trauma presented to the emergency department with severe vertigo, nausea, and decreased mobility. The patient was assessed and treated by a vestibular trained physiotherapist. The patient was treated with one Epley repositioning manoeuvre and had complete resolution of symptoms and was discharged home the same day. CONCLUSION: BPPV can be successfully identified and treated by vestibular trained physiotherapists in the emergency department. Early access to vestibular trained physiotherapy in the emergency department resulted in diagnosis and evidence-based treatment of BPPV which prevented hospital admission and improved this patient’s outcome. The patient had complete resolution of symptoms post the repositioning manoeuvre and was discharged to home.

EVESTA: Emergency VESTibular Algorithm and its impact on the acute management of benign paroxysmal positional vertigo.

To synthesise evidence-based research concerning the assessment and management of acute dizziness via construction of a comprehensive clinical algorithm. Assess its clinical impact with an aim to improve the acute management of benign paroxysmal positional vertigo (BPPV) within Wyong Public Hospital ED in four key recommendations. Current best practice models of care were synthesised into a single clinical, district-based peer-reviewed algorithm by a specialist focus group. An observational pre- and post-implementation study was completed to assess the impact of the algorithm on the management of BPPV. A total of 162 notes (pre [control] n=87 and post [intervention] n=75) met the inclusion criteria. Adherence to the BPPV clinical practice guidelines statements 1a, 3a, 4a and 6 were analysed for statistical difference in practice between the two groups. Following implementation of the Emergency VESTibular Algorithm (EVESTA), compliance showed a significant improvement in Hallpike-Dix performed by 27% (95% confidence interval [CI] 14-40%; defects pre-intervention 40%: post-intervention 13%) (P < 0.001), utilisation of neuroimaging reduced by 16% (95% CI 2-30%; 40%: 24%) (P < 0.05), repositioning techniques performed increased by 33% (95% CI 18-48%; 68%: 36%) (P < 0.001). Administration of vestibular suppressant medication reduced by 30% (95% CI 15-45%; 59%: 29%) (P < 0.001). An interrupted time series analysis confirmed significant change in BPPV admissions post-project -4.23% (95% CI -7.20, -1.27%) (P=0.041). Diagnosis and management of acute dizziness is challenging within the ED. Synthesis of best practice into a clinical algorithm has improved the diagnosis and evidence-based treatment of BPPV. There is continued opportunity to improve the efficiency and effectiveness in the management of both central and peripheral acute dizziness within the ED.