Eun-Hyeok Choi; Hyo-Jung Kim; Ji-Soo Kim

doi:10.21790/rvs.2024.018

Articles

Page Path: HOME > Res Vestib Sci > Volume 23(4); 2024 > Article

Review Article
Digital therapeutics and telemedicine for benign paroxysmal positional vertigo and other vestibular disorders: a review: Eun-Hyeok Choi¹, Hyo-Jung Kim², Ji-Soo Kim^1,3; Research in Vestibular Science 2024;23(4):115-123.
DOI: https://doi.org/10.21790/rvs.2024.018
Published online: December 15, 2024

¹Dizziness Center, Department of Neurology and Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, Korea

²Biomedical Research Institute, Seoul National University Bundang Hospital, Seongnam, Korea

³Department of Neurology, Seoul National University College of Medicine, Seoul, Korea

Corresponding author: Ji-Soo Kim Department of Neurology, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea E-mail: jisookim@snu.ac.kr

• Received: September 22, 2024 • Revised: October 17, 2024 • Accepted: October 18, 2024

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

342 Views
13 Download

Full Article

Download PDF

Abstract
INTRODUCTION
MAIN CONTENTS
CONCLUSION
ARTICLE INFORMATION
REFERENCES

Abstract

In the recent wave of digital transformation, digital therapeutics and telemedicine are changing the concepts in the management of benign paroxysmal positional vertigo and other vestibular disorders. These technologies provide accessible and cost-effective solutions amid the ongoing digital revolution in healthcare. This review article covers the recently advanced digital therapeutics for vestibular disorders that include questionnaire- or artificial intelligence-based diagnostic algorithms, telemedicine and self-application of canalith repositioning therapy, wearable devices for monitoring of eye movements during the attacks of dizziness/vertigo, and metaverse for vestibular rehabilitation. Integration of these digital technologies would improve diagnostic accuracy and treatment efficacy, reduce the economic burden associated with vestibular disorders, and promise a revolutionary shift in patient care towards personalized medicine.
Keywords: Telemedicine; Benign paroxysmal positional vertigo; Artificial intelligence; Mobile applications; Virtual reality

INTRODUCTION

In the current epoch of the Fourth Industrial Revolution, characterized by digital transformation and data proliferation, telemedicine and digital therapeutics are emerging trends in healthcare. The ubiquity of internet access and advancements in platform technology have facilitated these shifts, with the global pandemics further accelerating its adoption across every facet of medical care. According to a survey conducted by the American Medical Association in 2021 [1], approximately 85% of physicians are currently utilizing telehealth in some aspects of medical care. Furthermore, about 60% of these practitioners believe that telemedicine enables them to deliver more comprehensive and high-quality care to their patients. A simple search for ‘telemedicine’ on PubMed reveals a significant increase in publications on this subject from 2019 to 2020, doubling in number. This surge in academic interests emphasizes the growing importance and relevance of telemedicine in current healthcare, and the management of dizziness and vertigo is not an exception. This review aims to summarize recent developments in telemedicine and digital therapeutics in the management of vestibular disorders.

MAIN CONTENTS

Digital therapeutics for diagnosis and management of benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV) is the most prevalent vestibular disorder, responsible for 15% to 25% of visits to dizziness clinics [2]. BPPV may be recurrent with an annual recurrence rate of about 15%, and half of the recurrences are usually within 2 or 3 years [3]. The economic burden of BPPV is significant even though it varies across the countries. In the early 2000s, the estimated cost per hospital visit was about $2,000 in the United States [4], while in recent years, it was $600 in China (2019) [5], $450 in Spain (2008) [6], and $180 in South Korea (2017) [7]. A study conducted in 2008 suggested that the healthcare costs due to the BPPV approach are about $2 billion per year in the United States [8]. More recent research indicates that a patient with BPPV incurs $2,000 more as a direct medical cost annually, leading to an $11 billion increase in medical costs due to BPPV per year in the United States [9]. With the higher prevalence of BPPV in the aged population, the number of patients and the associated medical expenditure are expected to increase in the future. This highlights the urgent requirements for effective management strategies and the importance of telemedicine and digital therapeutics in providing cost-effective care for patients with BPPV.

The conventional approach to diagnosing BPPV involves a face-to-face detection of nystagmus during positioning maneuvers. The diagnosis is confirmed by the resolution of symptoms and nystagmus with canalith repositioning therapy (CRT). The efficacy of CRT may be improved when a home-based self-trial is combined with an office-based diagnosis and CRT [10-12]. There are devices on the market for proper performance of CRT at home, and instructional videos are readily available on platforms like Google and YouTube [13,14]. However, the application of CRT should be based on the correct identification of the BPPV subtype. According to the studies performed in Western countries, the posterior canal BPPV (PC-BPPV) predominates, accounting for more than 80% of cases in most studies, with a slight predilection for the right ear [15,16]. Thus, patients may attempt the maneuvers for right PC-BPPV first during an attack, and if it does not work, then those for left PC-BPPV. However, according to a multicenter study conducted in South Korea, the proportion of horizontal canal BPPV (HC-BPPV) is much higher, up to 30% to 40% [17]. This seems to be related to the interval from symptom onset to examination [17-19]. If patients are seen earlier during an attack of BPPV, the proportion of HC-BPPV is likely higher, probably due to a tendency of spontaneous resolution more for the HC-BPPV type. If there is a predilection for the subtype (same ear and same canal) in a certain patient, we can instruct the patient to perform the maneuver for the specific subtype of BPPV when the symptoms recur. However, studies have shown that only a quarter of patients show a recurrence as the same subtype (Fig. 1) [7]. This randomness of recurrences limits the efficacy of applying the CRT for the subtype during the previous attack when BPPV recurs. This highlights the need for accurate diagnosis of the BPPV subtype and specific treatment strategy for each patient during each attack.

Given these challenges in diagnosing BPPV, alternative routes have been explored. One is the adoption of questionnaires [20]. The symptoms of BPPV are quite characteristic, typically involving brief spells of isolated vertigo induced by head position changes, such as lying down, getting out of bed, or rolling over in bed [21]. Other disorders that can cause these kinds of characteristic symptoms are extremely rare. Furthermore, the involved ear and canal could be inferred from the positional changes that mostly trigger the vertigo, and the duration of each attack [22]. For instance, for the vertical canals, the head motions in the sagittal plane, such as lying down or getting up, are mostly involved. For the horizontal canals, in contrast, head motions mostly in the axial plane, such as turning over in bed, are mostly provocative.

A questionnaire was developed based on a group consensus by adopting the text-mining of the words that the patients with BPPV use when they report their symptoms [23]. It consists of six short questions, designed to diagnose BPPV and its subtypes (Table 1). The first three questions aim to exclude patients with dizziness/vertigo due to disorders other than BPPV. Patients who answered “yes” to all three questions proceed to the fourth question. The fourth question was designed to distinguish HC-BPPV from PC-BPPV. The fifth question determines the involved side. In patients with a presumed diagnosis of HC-BPPV from the fourth question, the responses to the fifth and sixth questions are used to decide the affected side and subtype (geotropic vs. apogeotropic). When the results of the questionnaire-based diagnosis were compared with those from bedside positional maneuvers, the accuracy of questionnaire-based diagnosis of BPPV was more than 70% [23].

Based on the acceptable accuracy of this questionnaire-based diagnostic algorithm [23], a multicenter, double-blind randomized controlled trial was conducted for web-guided self-treatment of recurrent BPPV in South Korea over 4.5 years [24]. A web-based system was developed for the questionnaire and for transferring the video clip for self-application of the CRT at home when BPPV recurs. Of the 728 patients with a confirmed and treated BPPV at the clinic, about 600 patients were randomized either to the treatment or control group after excluding the patients who could not access the internet or use the web-based program for any reason. The patients were instructed to access this web-based system with a preregistered code when they experienced similar attacks of positional vertigo. The patients in the treatment group were provided with a video clip that was designed for the specific subtype of BPPV diagnosed using the questionnaire. In contrast, the patients in the control group were provided with the video clip for the subtype of BPPV having been diagnosed during the previous attack, at the time of recruitment, without performing the questionnaire. The patients performed the CRT twice. The next day, they had a telephone interview to assess the resolution of positional vertigo. Depending on the subtype of BPPV, different maneuvers were applied: the modified Epley maneuver for PC-BPPV or anterior canal BPPV in the opposite ear, barbecue maneuver for geotropic HC-BPPV, and Gufoni maneuver for apogeotropic HC-BPPV. During the 2-year follow-up, 128 patients experienced recurrences, with 58 in the treatment group and 70 in the control group. This resulted in a 2-year recurrence rate of about 22%, similar to those reported in the previous studies [3,25]. Despite the exclusions at the time of recruitment, about 10% to 20% of patients could not access the web-based system during the attack, mostly due to severe symptoms without any family members to assist them. These patients were classified as treatment failures in the intention-to-treat analysis. Using the intention-to-treat analysis, 72.4% of patients in the treatment group reported resolution of vertigo, compared to 42.9% in the control group. This difference was statistically significant (chi-square test: 95% confidence interval, 0.13–0.46; p < 0.001), demonstrating the potential effectiveness of this questionnaire-based approach to diagnose and treat BPPV [24]. Thus, digital therapeutics could be a game changer in revolutionizing the ways of diagnosing and treating BPPV, and probably in every aspect of medical care in the future.

Use of artificial intelligence for diagnosis of benign paroxysmal positional vertigo and other vestibular disorders

Artificial intelligence may help in diagnosing vestibular disorders. In particular, the machine learning techniques can classify the subtype of BPPV using only the Dizziness Handicap Inventory (DHI) scores, offering a non-offending and easily accessible method [26,27]. Since the Frenzel glasses and nystagmus-recording devices are not always available or may be inconclusive, these technologies may be of help, especially for medical practitioners in resource-limited settings [27]. A deep learning model integrated into a decision support system showed promising results in classifying nystagmus patterns based on spatiotemporal characteristics using the video clips of positional nystagmus caused by BPPV [28]. This system showed a sensitivity of 80.8% and a specificity of 97.1% for the diagnosis of BPPV [28]. Similarly, another study reported a sensitivity of 88.5% and a specificity of 88.4% for the diagnosis of BPPV using a deep learning model by virtue of its ability to capture specific features and to handle high-frequency noise effectively. These technologies may allow an automatic classification of BPPV subtypes only using the video recording of positional nystagmus, thus relieving the burden of medical practitioners for differentiation of each subtype of BPPV.

Several studies have also attempted to differentiate episodic vestibular disorders such as vestibular migraine, Ménière’s disease, BPPV, and central dizziness even though it remains challenging due to their overlapping clinical presentations [29]. A study employed deep neural networks for the DizzyReg dataset and could diagnose vestibular migraine with an accuracy of 98.4% and Ménière’s disease with an accuracy of 98.0% [30,31]. Machine learning techniques were also able to classify central dizziness with a sensitivity of 94.4% and a specificity of 31.9%, using the commonly collected triage data, such as demographics, risk factors, vital signs, and clinical presentation, which could accelerate the diagnostic processes in the emergency department [32]. For Ménière’s disease, a computerized peer support system incorporated pattern recognition and achieved a diagnostic accuracy ranging from 82.1% to 96.6% [33]. A web-based algorithm model adopting the ‘constellatory reasoning’ for differential diagnosis of episodic vestibulopathy demonstrated a high specificity and predictive power with accuracy rates of 90% for BPPV, 86% for Ménière’s disease, and 92% for vestibular migraine [34]. These artificial intelligence-based trials offer an innovative approach to improve diagnostic accuracy and enhance clinical workflows, demonstrating the potential utility of machine learning in managing vestibular disorders.

Emerging devices for detecting eye movements during the attacks of episodic vestibular disorders

Evaluation of eye movements is crucial for the diagnosis of vestibular disorders. A variety of wearable and portable devices are being developed to detect nystagmus or abnormal eye movements during the attacks of episodic vestibular disorders. One such device is the mobile video-oculography system, which can be connected to a smartphone to record eye movements (Fig. 2) [35]. Another device is the wearable electrode system, also known as the vestibular telemetry device, designed to record eye movements over an extended period [36]. More simpler devices are also available, such as the EyeQue personal vision tracker (EyeQue Corp.), which aids in recording eye movements using a smartphone. An even simpler method involves recording a patient’s face using the EyeStabilizer (Vertify GmbH), which automatically traces the eyes and crops the eye region. These devices would provide valuable insights into the pathophysiology during the vertiginous attacks of episodic vestibular disorders [37]. The results of previous studies suggest that capturing ictal eye motion can be utilized in various ways in managing patients with dizziness/vertigo, such as detecting or ruling out BPPV, determining the vestibular origin of symptoms, identifying the affected side, enabling telemedicine, monitoring attack frequency, and even detecting malingering when proper guidance could be provided to the patients [38]. Indeed, a study highlighted the utility of smartphones in diagnosing BPPV, with a sensitivity of 92.9%, a specificity of 100%, and a negative predictive value of 97.9% based on the recording of eye movements during the Dix-Hallpike test [39,40]. This suggests that smartphones could be a valuable tool for telemedicine, especially for evaluating eye movements and balance function during the acute phase of vertigo [41]. The recording may also be utilized to triage the dizzy patients using telemedicine [42].

Likewise the advancements in technology for managing BPPV, similar strides have been made for other vestibular disorders, such as Ménière’s disease and vestibular migraine. Ménière’s disease is characterized by recurring episodes of vertigo, fluctuating sensorineural hearing loss that progressively worsens, and aural symptoms such as tinnitus and ear fullness [43]. A typical vertigo episode can last anywhere from 20 minutes to 12 hours [44]. The near-continuous tracking of eye and head movements in individuals suffering from dizziness for up to a month has proven useful in elucidating the patient’s symptoms [45]. This enables the identification of Ménière’s disease and its subtypes, such as bilateral involvements, by accurately determining the active ear and guiding the selection of the most suitable treatments [45].

Virtual reality tools for vestibular rehabilitation

Vestibular rehabilitation therapy is a well-established and effective treatment for central as well as peripheral vestibular dysfunction [46]. However, its success depends on the correct execution of exercises, which requires patient engagement and motivation [47]. The development of virtual reality (VR)-based vestibular rehabilitation therapy provides a powerful alternative to the traditional methods, effectively addressing these limitations [48,49]. This advanced approach includes real-time simulation, interactive features, and gaming components, offering an engaging training tool that motivates the patients to adhere to the therapy [50]. A variety of devices are available, from head-mounted systems and CAVE Automatic Virtual Environment (CAVE) settings (stationary large-scale environments that encompass the patient, providing peripheral optic flow) to commercially accessible devices like smartphones and the Nintendo Wii [51-53].

VR offers several unique benefits over traditional vestibular rehabilitation techniques. For instance, VR can customize the environment to align with the patient’s specific challenges. If a patient has trouble with an escalator, an escalator scene can be simulated to help them handle their symptoms while ‘experiencing’ an escalator through VR. Moreover, VR environments create a sense of being present in a real environment, triggering emotions similar to those experienced in actual life situations [54].

Several studies have reported positive results from the adoption of VR for vestibular rehabilitation therapy. For example, individuals who used a head-mounted VR device showed alterations in their vestibulo-ocular reflex gains [55,56]. It was also found that individuals with unilateral vestibular disorders demonstrated improved DHI scores, enhanced walking capabilities, and better balance after a year of VR training combined with traditional rehabilitation, compared to those who only underwent traditional rehabilitation [55,57].

Instruments like the Wii balance board, head-mounted devices, standing rotating discs, and VR CAVEs have all demonstrated their efficacy in enhancing balance in people with peripheral vestibular disorders [55,58-62]. As a consequence, VR is emerging as a therapeutic option for those suffering from vestibular disorders.

CONCLUSION

In conclusion, the management of vestibular disorders, particularly BPPV, is evolving with the advent of digital therapeutics. The questionnaire-based approach has shown promising results in diagnosing BPPV and its subtypes. The advent of web-based algorithms, machine learning techniques, and various devices for detecting eye movements represents a significant stride in this field. These tools and techniques, although in their early stages, hold immense potential in enhancing the care of dizzy patients. As these technologies become feasible, they could revolutionize the way we approach these disorders and reduce medical expenditure. Nevertheless, it should be acknowledged that differentiation of central from peripheral causes of vestibular disorders remains challenging even for seasoned neuro-otologists. This highlights the need for further advancements and researches to refine these technologies for enhancing diagnostic accuracy and ensuring reliable patient outcomes. Digital therapeutics could be a game changer in every aspect of medical care in the future.

ARTICLE INFORMATION

Funding/Support

None.

Conflicts of Interest

Ji-Soo Kim serves as an associate editor of Frontiers in Neuro-otology and on the editorial boards of the Journal of Clinical Neurology, Frontiers in Neuro-ophthalmology, Journal of Neuro-ophthalmology, Journal of Vestibular Research, and Clinical and Translational Neuroscience. Choi Eun-Hyeok and Hyo-Jung Kim report no disclosures relevant to the manuscript.

Availability of Data and Materials

All data generated or analyzed during this study are included in this published article. For other data, these may be requested through the corresponding author.

Authors’ Contributions

Conceptualization, Methodology: JSK; Data curation: HJK, JSK; Formal analysis: CEH, HJK; Investigation: CEH; Writing–original draft: CEH; Writing–review & editing: HJK, JSK.

All authors read and approved the final manuscript.

Fig. 1.

The patterns of recurrences in benign paroxysmal positional vertigo (BPPV). Only a quarter of patients with BPPV show a recurrence as the same subtype.

Fig. 2.

A mobile video-oculography system. These carriable video goggles can be connected to the smartphone for visualization and recording of eye movements. Written informed consent was obtained from the patient for the publication of this report including all clinical images.

Table 1.

The questionnaire for self-diagnosis of benign paroxysmal positional vertigo

Question No.	Self-diagnosis question
Question 1	Do you have a spinning or a whirling sensation of the surroundings or yourself?
Question 2	Do you feel dizzy mostly when your head is moved?
Question 3	Does the dizziness last <3 min?
Question 4	Which positional change makes you feel dizzier?
	(1) Lying down or getting out of bed?
	(2) Turning your head (or body) while lying down?
Question 5	Which makes you dizzier?
	(1) Turning your head to the right?
	(2) Turning your head to the left?
Question 6	How long does the dizziness induced by head turning last?
	(1) < 1 min?
	(2) >1 min?

REFERENCES

1. American Medical Association (AMA). 2021 Telehealth survey report. AMA; 2022.
2. Kim HJ, Lee JO, Choi JY, Kim JS. Etiologic distribution of dizziness and vertigo in a referral-based dizziness clinic in South Korea. J Neurol 2020;267:2252–2259. Article PubMed PDF
3. Nunez RA, Cass SP, Furman JM. Short- and long-term outcomes of canalith repositioning for benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 2000;122:647–652. Article PDF
4. Li JC, Li CJ, Epley J, Weinberg L. Cost-effective management of benign positional vertigo using canalith repositioning. Otolaryngol Head Neck Surg 2000;122:334–339. Article PubMed PDF
5. Wang YL, Wu MY, Cheng PL, Pei SF, Liu Y, Liu YM. Analysis of cost and effectiveness of treatment in benign paroxysmal positional vertigo. Chin Med J (Engl) 2019;132:342–345. Article PubMed PMC
6. Pérez P, Manrique C, Alvarez MJ, et al. Evaluation of benign paroxysmal positional vertigo in primary health-care and first level specialist care. Acta Otorrinolaringol Esp 2008;59:277–282. Article PubMed
7. Kim HJ, Kim JS. The patterns of recurrences in idiopathic benign paroxysmal positional vertigo and self-treatment evaluation. Front Neurol 2017;8:690. Article PubMed PMC
8. Bhattacharyya N, Gubbels SP, Schwartz SR, et al. Clinical practice guideline: benign paroxysmal positional vertigo (update). Otolaryngol Head Neck Surg 2017;156(3 Suppl):S1–S47.
9. Jeong SS, Simpson KN, Johnson JM, Rizk HG. Assessment of the cost burden of episodic recurrent vestibular vertigo in the US. JAMA Otolaryngol Head Neck Surg 2022;148:1103–1110. Article PubMed PMC
10. Piromchai P, Eamudomkarn N, Srirompotong S, Ratanaanekchai T, Yimtae K. The efficacy of a home treatment program combined with office-based canalith repositioning procedure for benign paroxysmal positional vertigo: a randomized controlled trial. Otol Neurotol 2019;40:951–956. Article PubMed
11. Tanimoto H, Doi K, Katata K, Nibu KI. Self-treatment for benign paroxysmal positional vertigo of the posterior semicircular canal. Neurology 2005;65:1299–1300. Article PubMed
12. Bromwich M, Hughes B, Raymond M, Sukerman S, Parnes L. Efficacy of a new home treatment device for benign paroxysmal positional vertigo. Arch Otolaryngol Head Neck Surg 2010;136:682–685. Article PubMed
13. Physiotutors. Gufoni maneuver: lateral BPPV treatment [YouTube]. Physiotutors; 2023 [cited 2024 Oct 22]. Available from: https://www.youtube.com/watch?v=uA9ZcKbPAz8
14. Physiotutors. Modified Epley maneuver: posterior BPPV Treatment [YouTube]. Physiotutors; 2023 [cited 2024 Oct 22]. Available from: https://www.youtube.com/watch?v=u23Wuj6zVLM
15. Korres S, Balatsouras DG, Kaberos A, Economou C, Kandiloros D, Ferekidis E. Occurrence of semicircular canal involvement in benign paroxysmal positional vertigo. Otol Neurotol 2002;23:926–932. Article PubMed
16. Soto-Varela A, Santos-Perez S, Rossi-Izquierdo M, Sanchez-Sellero I. Are the three canals equally susceptible to benign paroxysmal positional vertigo? Audiol Neurootol 2013;18:327–334. Article PubMed PDF
17. Moon SY, Kim JS, Kim BK, et al. Clinical characteristics of benign paroxysmal positional vertigo in Korea: a multicenter study. J Korean Med Sci 2006;21:539–543. Article PubMed PMC
18. Korres SG, Balatsouras DG. Diagnostic, pathophysiologic, and therapeutic aspects of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 2004;131:438–444. Article PubMed PDF
19. Uno A, Moriwaki K, Kato T, Nagai M, Sakata Y. Clinical features of benign paroxysmal positional vertigo. Nihon Jibiinkoka Gakkai Kaiho 2001;104:9–16. Article PubMed
20. Lindell E, Finizia C, Johansson M, Karlsson T, Nilson J, Magnusson M. Asking about dizziness when turning in bed predicts examination findings for benign paroxysmal positional vertigo. J Vestib Res 2018;28:339–347. Article PubMed
21. van Dam VS, Maas BD, Schermer TR, van Benthem PG, Bruintjes TD. Two symptoms strongly suggest benign paroxysmal positional vertigo in a dizzy patient. Front Neurol 2021;11:625776. Article PubMed PMC
22. Higashi-Shingai K, Imai T, Kitahara T, et al. Diagnosis of the subtype and affected ear of benign paroxysmal positional vertigo using a questionnaire. Acta Otolaryngol 2011;131:1264–1269. Article PubMed
23. Kim HJ, Song JM, Zhong L, Yang X, Kim JS. Questionnaire-based diagnosis of benign paroxysmal positional vertigo. Neurology 2020;94:e942–e949. Article PubMed
24. Kim HJ, Kim JS, Choi KD, et al. Effect of self-treatment of recurrent benign paroxysmal positional vertigo: a randomized clinical trial. JAMA Neurol 2023;80:244–250. Article PubMed PMC
25. Sakaida M, Takeuchi K, Ishinaga H, Adachi M, Majima Y. Long-term outcome of benign paroxysmal positional vertigo. Neurology 2003;60:1532–1534. Article PubMed
26. Kabade V, Hooda R, Raj C, et al. Machine learning techniques for differential diagnosis of vertigo and dizziness: a review. Sensors (Basel) 2021;21:7565. Article PubMed PMC
27. Masankaran L, Viyanon W, Mahasittiwat V. Classification of benign paroxysmal positioning vertigo types from Dizziness Handicap Inventory using machine learning techniques. In: Proceedings of the 2018 International Conference on Intelligent Informatics and Biomedical Sciences (ICIIBMS); 2018 Oct; Bangkok, Thailand. IEEE; 2018:209-14.
28. Lim EC, Park JH, Jeon HJ, et al. Developing a diagnostic decision support system for benign paroxysmal positional vertigo using a deep-learning model. J Clin Med 2019;8:633. Article PubMed PMC
29. Mok B, Welgampola MS, Rosengren SM. Vestibular migraine as a mimic of benign paroxysmal positioning vertigo and Meniere’s disease. J Vestib Res 2024;Sep 5 [Epub]. https://doi.org/10.3233/VES-240038Article PubMed
30. Grill E, Müller T, Becker-Bense S, et al. DizzyReg: the prospective patient registry of the German Center for Vertigo and Balance Disorders. J Neurol 2017;264(Suppl 1):34–36. Article PubMed PDF
31. Groezinger M, Huppert D, Strobl R, Grill E. Development and validation of a classification algorithm to diagnose and differentiate spontaneous episodic vertigo syndromes: results from the DizzyReg patient registry. J Neurol 2020;267(Suppl 1):160–167. Article PubMed PMC PDF
32. Kim BJ, Jang SK, Kim YH, et al. Diagnosis of acute central dizziness with simple clinical information using machine learning. Front Neurol 2021;12:691057. Article PubMed PMC
33. Rasku J, Pyykkö I, Levo H, Kentala E, Manchaiah V. Disease profiling for computerized peer support of Ménière’s disease. JMIR Rehabil Assist Technol 2015;2:e9. Article PubMed PMC
34. Feil K, Feuerecker R, Goldschagg N, et al. Predictive capability of an iPad-based medical device (medx) for the diagnosis of vertigo and dizziness. Front Neurol 2018;9:29. Article PubMed PMC
35. Melliti A, van de Berg M, van de Berg R. Capturing nystagmus during vertigo attacks using a smartphone: adherence, characteristics, pearls and pitfalls. J Neurol 2023;270:6044–6056. Article PubMed PMC PDF
36. Phillips JS, Newman JL, Cox SJ. Clinical techniques and technology: vestibular telemetry. Otolaryngol Head Neck Surg 2021;165:751–753. Article PubMed PMC PDF
37. Lee SU, Kim HJ, Choi JY, Kim JS. Ictal downbeat nystagmus in Ménière disease: a cross-sectional study. Neurology 2020;95:e2409–e2417. Article PubMed
38. Young AS, Lechner C, Bradshaw AP, et al. Capturing acute vertigo: a vestibular event monitor. Neurology 2019;92:e2743–e2753. Article PubMed
39. Shah MU, Lotterman S, Roberts D, Eisen M. Smartphone telemedical emergency department consults for screening of nonacute dizziness. Laryngoscope 2019;129:466–469. Article PubMed PDF
40. Murdin L, Saman Y, Rea P. The remote neuro-otology assessment: managing dizziness in the coronavirus disease 2019 era. J Laryngol Otol 2020;134:1120–1122. Article PubMed PMC
41. Green KE, Pogson JM, Otero-Millan J, et al. Opinion and special articles: remote evaluation of acute vertigo: strategies and technological considerations. Neurology 2021;96:34–38. Article PubMed PMC
42. Müller-Barna P, Hubert ND, Bergner C, et al. TeleVertigo: diagnosing stroke in acute dizziness: a telemedicine-supported approach. Stroke 2019;50:3293–3298. Article PubMed
43. Lopez-Escamez JA, Carey J, Chung WH, et al. Diagnostic criteria for Menière’s disease. J Vestib Res 2015;25:1–7. Article PubMed
44. Claes GM, De Valck CF, Van de Heyning P, Wuyts FL. The Ménière’s Disease Index: an objective correlate of Ménière’s disease, based on audiometric and electrocochleographic data. Otol Neurotol 2011;32:887–892. Article PubMed
45. Phillips JS, Newman JL, FitzGerald JE, Cox SJ. Implications of vestibular telemetry for the management of Ménière’s disease: our experience with three adults. Clin Otolaryngol 2021;46:425–429. Article PMC PDF
46. Jung JY, Kim JS, Chung PS, Woo SH, Rhee CK. Effect of vestibular rehabilitation on dizziness in the elderly. Am J Otolaryngol 2009;30:295–299. Article PubMed
47. Kalderon L, Kaplan A, Wolfovitz A, Levy-Tzedek S, Gimmon Y. Barriers and facilitators of vestibular rehabilitation: patients and physiotherapists’ perspectives. J Neurol Phys Ther 2024;48:140–150. Article PubMed PMC
48. Morel M, Bideau B, Lardy J, Kulpa R. Advantages and limitations of virtual reality for balance assessment and rehabilitation. Neurophysiol Clin 2015;45:315–326. Article PubMed
49. Tarr MJ, Warren WH. Virtual reality in behavioral neuroscience and beyond. Nat Neurosci 2002;5 Suppl:1089–1092. Article PDF
50. Whitney SL, Sparto PJ, Hodges LF, Babu SV, Furman JM, Redfern MS. Responses to a virtual reality grocery store in persons with and without vestibular dysfunction. Cyberpsychol Behav 2006;9:152–156. Article PubMed
51. Sparrer I, Duong Dinh TA, Ilgner J, Westhofen M. Vestibular rehabilitation using the Nintendo® Wii Balance Board: a user-friendly alternative for central nervous compensation. Acta Otolaryngol 2013;133:239–245. Article PubMed
52. Nikitas C, Kikidis D, Pardalis A, et al. Head mounted display effect on vestibular rehabilitation exercises performance. J Frailty Sarcopenia Falls 2023;8:66–73. Article
53. Hall CD, Herdman SJ, Whitney SL, et al. Vestibular rehabilitation for peripheral vestibular hypofunction: an updated clinical practice guideline from the Academy of Neurologic Physical Therapy of the American Physical Therapy Association. J Neurol Phys Ther 2022;46:118–177. Article PubMed PMC
54. Nash EB, Edwards GW, Thompson JA, Barfield W. A review of presence and performance in virtual environments. Int J Hum Comput Interact 2000;12:1–41. Article
55. Micarelli A, Viziano A, Augimeri I, Micarelli D, Alessandrini M. Three-dimensional head-mounted gaming task procedure maximizes effects of vestibular rehabilitation in unilateral vestibular hypofunction: a randomized controlled pilot trial. Int J Rehabil Res 2017;40:325–332. Article
56. Viziano A, Micarelli A, Augimeri I, Micarelli D, Alessandrini M. Long-term effects of vestibular rehabilitation and head-mounted gaming task procedure in unilateral vestibular hypofunction: a 12-month follow-up of a randomized controlled trial. Clin Rehabil 2019;33:24–33. Article PubMed PDF
57. Hondebrink MS, Mert A, van der Lint R, de Ru JA, van der Wurff P. Motion-based equilibrium reprocessing therapy a novel treatment method for chronic peripheral vestibulopathies: a pilot study. Medicine (Baltimore) 2017;96:e7128. Article PubMed PMC
58. Alahmari KA, Sparto PJ, Marchetti GF, Redfern MS, Furman JM, Whitney SL. Comparison of virtual reality based therapy with customized vestibular physical therapy for the treatment of vestibular disorders. IEEE Trans Neural Syst Rehabil Eng 2014;22:389–399. Article PubMed PMC
59. Garcia AP, Ganança MM, Cusin FS, Tomaz A, Ganança FF, Caovilla HH. Vestibular rehabilitation with virtual reality in Ménière’s disease. Braz J Otorhinolaryngol 2013;79:366–374. Article PubMed PMC
60. Meldrum D, Herdman S, Vance R, et al. Effectiveness of conventional versus virtual reality-based balance exercises in vestibular rehabilitation for unilateral peripheral vestibular loss: results of a randomized controlled trial. Arch Phys Med Rehabil 2015;96:1319–1328. Article PubMed
61. Pavlou M, Kanegaonkar RG, Swapp D, Bamiou DE, Slater M, Luxon LM. The effect of virtual reality on visual vertigo symptoms in patients with peripheral vestibular dysfunction: a pilot study. J Vestib Res 2012;22:273–281. Article PubMed
62. Rosiak O, Krajewski K, Woszczak M, Jozefowicz-Korczynska M. Evaluation of the effectiveness of a virtual reality-based exercise program for unilateral peripheral vestibular deficit. J Vestib Res 2018;28:409–415. Article PubMed PMC

Figure & Data

References

Citations

Citations to this article as recorded by

PubReader
ePub Link

Cite

CITE: export Copy Format; Close

Download Citation

Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

Format:

RIS — For EndNote, ProCite, RefWorks, and most other reference management software
BibTeX — For JabRef, BibDesk, and other BibTeX-specific software

Include:

Citation for the content below
Citation and abstract for the content below

Digital therapeutics and telemedicine for benign paroxysmal positional vertigo and other vestibular disorders: a review

Res Vestib Sci. 2024;23(4):115-123. Published online December 15, 2024

DOI: https://doi.org/10.21790/rvs.2024.018

XML Download

Figure

Related articles

Digital therapeutics and telemedicine for benign paroxysmal positional vertigo and other vestibular disorders: a review

Fig. 1. The patterns of recurrences in benign paroxysmal positional vertigo (BPPV). Only a quarter of patients with BPPV show a recurrence as the same subtype.

Fig. 2. A mobile video-oculography system. These carriable video goggles can be connected to the smartphone for visualization and recording of eye movements. Written informed consent was obtained from the patient for the publication of this report including all clinical images.

Fig. 1.

Fig. 2.

Digital therapeutics and telemedicine for benign paroxysmal positional vertigo and other vestibular disorders: a review

Question No.	Self-diagnosis question
Question 1	Do you have a spinning or a whirling sensation of the surroundings or yourself?
Question 2	Do you feel dizzy mostly when your head is moved?
Question 3	Does the dizziness last <3 min?
Question 4	Which positional change makes you feel dizzier?
	(1) Lying down or getting out of bed?
	(2) Turning your head (or body) while lying down?
Question 5	Which makes you dizzier?
	(1) Turning your head to the right?
	(2) Turning your head to the left?
Question 6	How long does the dizziness induced by head turning last?
	(1) < 1 min?
	(2) >1 min?

Table 1. The questionnaire for self-diagnosis of benign paroxysmal positional vertigo