Assessment for benign paroxysmal positioning vertigo in medical patients admitted with falls in a district general hospital

Editor – Abbott et al¹ imply that benign paroxysmal positioning vertigo (BPPV) may be overlooked in patients admitted to a district general hospital with falls and, ipsi facto, that this condition might be the cause of such falls. This cannot be justified on the basis of the data presented in this paper.

Although the authors describe in their introduction the diagnostic criteria for BPPV, to my surprise, in their short results section they make no mention of whether (a) the patient actually had the characteristic symptoms of BPPV, as opposed to falls alone; or (b) the characteristic pattern of nystagmus was elicited during the provocative Dix-Hallpike manoeuvre (that is, a torsional and horizontal nystagmus beating towards the lower ear, which develops after a latency of a few seconds, persists for 10–15 seconds and is accompanied by vertigo²); nor did they include laterality or which semi-circular canals were implicated in the falls. They simply state that ‘20 were positive for BPPV (54%) and 17 patients were negative’.

Abbott et al did not consider that the falls were the cause of any BPPV. By way of example, a few days ago I examined an older patient with a minor head injury after a fall in his bathroom who began the history of their dizziness, which developed soon thereafter, with: ‘doctor, when I roll over in bed…’– they hardly need go on and sure enough have typical neuro-opthalmic findings of BPPV referable to the left side. This relationship to injury is a common observation in office-based practice.

Over recent years, BPPV has become a well-recognised entity but practitioners tend to apply this manoeuvre in situations where this is inappropriate, such as an acute vestibulopathy (eg vestibular neuronitis), and where the patient is acutely dizzy and provocative head manoeuvres serve only to make the patient feel worse. This does not equate to BPPV caused by cupulolithiasis.

Although they describe the Epley manoeuvre particle repositioning manoeuvre, the authors did not provide any information as to whether their patients with falls were assisted by this.

More information is essential for readers of your journal to accept these authors’ recommendation that ‘all patients admitted with falls are assessed for BPPV to minimise their risk of further falls’.

Conflicts of interest

The author has no conflicts of interest to declare.