2023 American Academy of Neurology Abstract Website

Objective:

The aim of this world wide survey was to evaluate the currently used treatment options of the six most frequent peripheral vestibular disorders: benign paroxysmal positional vertigo (BPPV), acute unilateral vestibulopathy (AUVP)/vestibular neuritis, Menière's disease, bilateral vestibulopathy (BVP), vestibular paroxysmia and superior canal deshiscence syndrome (SCDS).

Background:

For the therapy of vestibular disorders, there are basically four treatment options: physiotherapy (liberatory maneuvers or balance training), pharmacotherapy, surgery and psychotherapy. Since there are very few state-of-the-art RCTs, the treatment of vestibular disorders is so far not standardized and various methods are applied with heterogeneous efficacy.

Design/Methods:

A web-based standardized survey questionnaire on the treatment of the six most frequent peripheral vestibular disorders was used to collect data.

Results:

234 replies from five continents, 47 countries, 162 cities and 188 centers were received: (% from all 234 replies; multiple answers possible): BPPV: posterior canal: 71% Epley, 40% Sémont, and 12% others. Horizontal canal BPPV canalithiasis: 58% roll-maneuver, 33% Gufoni, 7% prolonged rest, and 9% others. Horizontal canal cupulolithiasis: 35% Gufoni, 27% roll-maneuver, 9% Zuma, and 7% head shaking: AUVP: 79% pharmacotherapy, namely 47% glucocorticoids, 39% antiemetics, and 24% betahistine; 67% physiotherapy. Menière's disease: 85% pharmacotherapy, namely 65% betahistine, 21% diuretics, 20% steroids, 16% antiemetics, 14% gentamicin; 37% surgery. Vestibular paroxysmia: 65% pharmacotherapy, namely 57% anticonvulsants; 7% surgery. BVP: 77% physiotherapy. SCDS: 50% Surgery, namely 19% canal plugging, 12% capping, and 8% resurfacing.

Conclusions:

In this world wide survey with 234 replies from 188 centers widely heterogeneous applied treatment options were reported for the six most frequent peripheral vestibular disorders. For example, medication use is often not supported by evidence. Namely in AUVP, Menière's disease and vestibular paroxysmia well designed controlled trials are needed with clinically meaningful endpoints are needed.