Treatment of Dizziness

Diagnosis and Classification of Dizziness

The American Academy of Otolaryngology-Head and Neck Surgery recommends classifying dizziness into one of four categories to guide treatment: vertigo, presyncope, disequilibrium, or lightheadedness, with the Dix-Hallpike maneuver and supine roll test used to diagnose posterior and lateral canal BPPV, respectively 1, 3

The American Academy of Otolaryngology-Head and Neck Surgery recommends the Canalith Repositioning Procedure (Epley maneuver) as the treatment of choice for posterior canal BPPV, with success rates of 90-98% when performed correctly 1, 4
For lateral canal BPPV, the Gufoni maneuver or barbecue roll maneuver should be used, with success rates ranging from 86-100% 2
Vestibular suppressant medications should NOT be routinely prescribed for BPPV treatment as they do not address the underlying cause, according to the American Academy of Otolaryngology-Head and Neck Surgery 1, 4

For Ménière's disease, treatment includes salt restriction, diuretics, and short-term vestibular suppressants during acute attacks, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 5
Vestibular rehabilitation therapy should be considered for patients with persistent dizziness from vestibular causes, according to the American Academy of Otolaryngology-Head and Neck Surgery 4

For dizziness associated with heart failure and low blood pressure, careful medication management is required, with SGLT2 inhibitors and MRAs being preferred as they typically do not lower blood pressure significantly, as recommended by the European Society of Cardiology 6

Meclizine may be used short-term for severe nausea/vomiting associated with vertigo, but not as primary treatment, according to the American Academy of Otolaryngology-Head and Neck Surgery 5
Vestibular suppressants should be used cautiously, especially in elderly patients, due to side effects including drowsiness, cognitive deficits, and increased fall risk, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 5

Patients should be reassessed within 1 month after initial treatment to document resolution or persistence of symptoms, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1, 7
For persistent symptoms, evaluate for unresolved BPPV, canal conversion, or underlying peripheral vestibular or central nervous system disorders, according to the American Academy of Otolaryngology-Head and Neck Surgery 7, 2