Subscribe to RSS
Please copy the URL and add it into your RSS Feed Reader.
https://www.thieme-connect.de/rss/thieme/en/10.1055-s-00025477.xml
CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2021; 25(01): e141-e149
DOI: 10.1055/s-0040-1722252
DOI: 10.1055/s-0040-1722252
Original Research
Special Article COVID-19
Teleconsultation and Teletreatment Protocol to Diagnose and Manage Patients with Benign Paroxysmal Positional Vertigo (BPPV) during the COVID-19 Pandemic
Abstract
Introduction Telehealth consists in the application of technology to provide remote health service. This resource is considered safe and effective and has attracted an exponential interest in the context of the COVID pandemic. Expanded to dizzy patients, it would be able to provide diagnosis and treatment, minimizing the risk of disease transmission. Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder. The diagnosis typically rests on the description of the symptoms along with the nystagmus observed at a well-established positional testing.
Objectives The aim of the present study was to propose a teleconsultation and teletreatment protocol to manage patients with BPPV during the COVID-19 pandemic.
Methods Specialists in the vestibular field met through remote access technologies to discuss the best strategy to manage BPPV patients by teleconsultation and teletreatment system. Additionally, several scientific sources were consulted. Technical issues, patient safety, and clinical assessment were independently analyzed. All relevant information was considered in order to design a clinical protocol to manage BPPV patients in the pandemic context.
Results Teleconsultation for BPPV patients requires a double way (video and audio) digital system. An adapted informed consent to follow good clinical practice statements must be considered. The time, trigger and target eye bedside examination (TiTRaTe) protocol has proven to be a valuable first approach. The bow and lean test is the most rational screening maneuver for patients with suspected positional vertigo, followed by most specific maneuvers to diagnostic the sub-variants of BPPV.
Conclusion Although with limited evidence, teleconsultation and teletreatment are both reasonable and feasible strategies for the management of patients with BPPV in adverse situations for face-to-face consultation.
Publication History
Received: 16 September 2020
Accepted: 10 November 2020
Article published online:
01 February 2021
© 2021. Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
-
References
- 1 Bogoch II, Watts A, Thomas-Bachli A, Huber C, Kraemer MUG, Khan K. Potential for global spread of a novel coronavirus from China. J Travel Med 2020; 27 (02) taaa011 DOI: 10.1093/jtm/taaa011.
- 2 Lu R, Zhao X, Li J. et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020; 395 (10224): 565-574 DOI: 10.1016/s0140-6736(20)30251-8.
- 3 World Health Organization. WHO Director - General's remarks at the media briefing on 2019-nCoV on 11 February 2020[EB/OL]. 2020 . Accessed May 02, 2020 at https://www.who.int/dg/speeches/detail/who-director-general-s-remarks-at-the-media-briefing-on-2019-ncov-on-11-february-2020
- 4 International Committee on Taxonomy of Viruses. Naming the 2019 Coronavirus. Accessed May 15, 2020 at: https://talk.ictvonline.org/
- 5 Wilder-Smith A, Freedman DO. Isolation, quarantine, social distancing and community containment: pivotal role for old-style public health measures in the novel coronavirus (2019-nCoV) outbreak. J Travel Med 2020; 27 (02) taaa020 DOI: 10.1093/jtm/taaa020.
- 6 World Health Organization. Considerations for quarantine of individuals in the context of containment for coronavirus disease (COVID-19): interim guidance, 19 march 2020. Geneva: 2020 Mar 19. 4 f. Accessed May 20, 2020 at: https://apps.who.int/iris/handle/10665/331497
- 7 Diário Oficial da União Law n°. 13979, of February 6, 2020. Provides for measures to deal with the public health emergency of international importance resulting from the coronavirus responsible for the 2019 outbreak. Diário Oficial da União, Brasília, DF, ed. 27, section 1, p. 1, 7 Feb 2020. 2020 . Accessed April 17, 2020 at: http://www.in.gov.br/en/web/dou/-/lei-n-13.979-de-6-de-fevereiro-de-2020-242078735
- 8 Anderson RH, Klinkenberg D, Hollingsworth TD. How will country-based mitigation measures influence the course of the Covid-19 epidemic? Lancet [Internet]. 2020 Mar. 2020: Accessed May 05, 2020 at: https://doi.org/10.1016/S0140-6736(20)30567-5
- 9 Qualls N, Levitt A, Kanade N, Wright-Jegede N, Dopson S, Biggerstaff M. et al. Community mitigation guidelines to prevent pandemic influenza - United States, 2017. Recommendations and Reports / April 21, 2017 / 66(1). 1-34 2020 Accessed May 05, 2020 at: https://www.cdc.gov/mmwr/volumes/66/rr/rr6601a1.htm#contribAff
- 10 von Brevern M, Radtke A, Lezius F. et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry 2007; 78 (07) 710-715 DOI: 10.1136/jnnp.2006.100420.
- 11 Wackym PA, Snow JJB. Ballenger’s Otorhinolaryngology: Head and Neck Surgery. 2009 Pmph USA Ltd Series S (1550093371, 9781550093377):1209
- 12 Schappert SM. National Ambulatory Medical Care Survey: 1989 summary. Vital and health statistics Series 13, Data from the National Health Survey. 1992 110. 1-80
- 13 Katsarkas A. Benign paroxysmal positional vertigo (BPPV): idiopathic versus post-traumatic. Acta Otolaryngol 1999; 119 (07) 745-749 DOI: 10.1080/00016489950180360.
- 14 Hanley K, O'Dowd T, Considine N. A systematic review of vertigo in primary care. Br J Gen Pract 2001; 51 (469) 666-671
- 15 Lüscher M, Theilgaard S, Edholm B. Prevalence and characteristics of diagnostic groups amongst 1034 patients seen in ENT practices for dizziness. J Laryngol Otol 2014; 128 (02) 128-133 DOI: 10.1017/s0022215114000188.
- 16 Royl G, Ploner CJ, Leithner C. Dizziness in the emergency room: diagnoses and misdiagnoses. Eur Neurol 2011; 66 (05) 256-263 DOI: 10.1159/000331046.
- 17 Givens GD, Elangovan S. Internet application to tele-audiology--“nothin' but net”. Am J Audiol 2003; 12 (02) 59-65 DOI: 10.1044/1059-0889(2003/011).
- 18 Lancaster P, Krumm M, Ribera J, Klich R. Remote hearing screenings via telehealth in a rural elementary school. Am J Audiol 2008; 17 (02) 114-122 DOI: 10.1044/1059-0889(2008/07-0008).
- 19 Conselho Federal de Fisioterapia e Terapia Ocupacional (COFFITO). RESOLUTION n°. 516, of March 20, 2020–Teleconsultation, Telemonitoring and Teleconsulting. Accessed May 18, 2020 at: https://www.coffito.gov.br/nsite/?p=15825
- 20 Wechsler LR, Demaerschalk BM, Schwamm LH, Adeoye OM, Audebert HJ, Fanale CV. et al. Telemedicine Quality and Outcomes in Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2017; 48 (01) 3e25 DOI: 10.1161/STR.0000000000000114.
- 21 Viirre E, Warner D, Balch D, Nelson JR. Remote medical consultation for vestibular disorders: technological solutions and case report. Telemed J 1997; 3 (01) 53-58 DOI: 10.1089/tmj.1.1997.3.53.
- 22 Shah MU, Lotterman S, Roberts D, Eisen M. Smartphone telemedical emergency department consults for screening of nonacute dizziness. Laryngoscope 2019; 129 (02) 466-469 DOI: 10.1002/lary.27424.
- 23 Arriaga MA, Nuss D, Scrantz K. et al. Telemedicine-assisted neurotology in post-Katrina Southeast Louisiana. Otol Neurotol 2010; 31 (03) 524-527 DOI: 10.1097/MAO.0b013e3181cdd69d.
- 24 Seim NB, Philips RHW, Matrka LA. et al. Developing a synchronous otolaryngology telemedicine Clinic: Prospective study to assess fidelity and diagnostic concordance. Laryngoscope 2018; 128 (05) 1068-1074 DOI: 10.1002/lary.26929.
- 25 Kıroğlu M, Dağkıran M. The Role of Mobile Phone Camera Recordings in the Diagnosis of Meniere's Disease and Pathophysiological Implications. J Int Adv Otol 2020; 16 (01) 18-23 DOI: 10.5152/iao.2019.6605.
- 26 van Vugt VA, van der Wouden JC, Essery R. et al. Internet based vestibular rehabilitation with and without physiotherapy support for adults aged 50 and older with a chronic vestibular syndrome in general practice: three armed randomised controlled trial. BMJ 2019; 367: l5922 DOI: 10.1136/bmj.l5922.
- 27 U.S. Department of Health & Human Services. Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency. Accessed May 12, 2020 at: https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html
- 28 Conselho Regional de Fisioterapia e Terapia Ocupacional 2 (CREFITO 2). Telehealth: online consultation. Accessed May 12, 2020 at: http://www.crefito2.gov.br/clientes/crefito2/fotos//CartilhaTELESSAUDE.pdf
- 29 Giordano V, Koch H, Godoy-Santos A, Dias Belangero W, Esteves Santos Pires R, Labronici P. WhatsApp Messenger as an Adjunctive Tool for Telemedicine: An Overview. Interact J Med Res 2017; 6 (02) e11 DOI: 10.2196/ijmr.6214.
- 30 Newman-Toker DE, Edlow JA. TiTrATE: A Novel, Evidence-Based Approach to Diagnosing Acute Dizziness and Vertigo. Neurologic clinics 2015; 33 (03) 577-99 , viii DOI: 10.1016/j.ncl.2015.04.011.
- 31 Neuhauser HK. Epidemiology of vertigo. Curr Opin Neurol 2007; 20 (01) 40-46 DOI: 10.1097/WCO.0b013e328013f432.
- 32 Caldas MA, Ganança CF, Ganança FF, Ganança MM, Caovilla HH. Clinical features of benign paroxysmal positional vertigo. Rev Bras Otorrinolaringol (Engl Ed) 2009; 75 (04) 502-506
- 33 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 (3-4): 339-347 DOI: 10.3233/VES-180637.
- 34 Kerber KA, Baloh RW. The evaluation of a patient with dizziness. Neurol Clin Pract 2011; 1 (01) 24-33 DOI: 10.1212/CPJ.0b013e31823d07b6.
- 35 American Academy of Neurology. Telemedicine and COVID-19. Accessed may 17, 2020 at: https://www.aan.com/siteassets/home-page/tools-and-resources/practicing-neurologist--administrators/telemedicine-and-remote-care/20200326-Telemedicine-and-covid-19-final.pdf
- 36 American Academy of Neurology. NeuroBytes: The Neurologic Exam Via Telemedicine. Accessed May 18, 2020 at: https://learning.aan.com/diweb/catalog/item?id=5033281
- 37 Lee JB, Han DH, Choi SJ. et al. Efficacy of the “bow and lean test” for the management of horizontal canal benign paroxysmal positional vertigo. Laryngoscope 2010; 120 (11) 2339-2346 DOI: 10.1002/lary.21117.
- 38 Choung YH, Shin YR, Kahng H, Park K, Choi SJ. 'Bow and lean test' to determine the affected ear of horizontal canal benign paroxysmal positional vertigo. Laryngoscope 2006; 116 (10) 1776-1781 DOI: 10.1097/01.mlg.0000231291.44818.be.
- 39 Choo O-S, Kim H, Jang JH, Park HY, Choung Y-H. Vertical Nystagmus in the Bow and Lean Test may Indicate Hidden Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo: Hypothesis of the Location of Otoconia. Sci Rep 2020; 10 (01) 6514 DOI: 10.1038/s41598-020-63630-3.
- 40 Pereira CB, Scaff M. Benign paroxysmal positioning vertigo. Arq Neuro-Psiquiatr. São Paulo June 2001. ;59 no.2B.
- 41 Liang XH, Sun PY, Peng X, Liu JM, Chen Z, Shan XZ. [Significance of the seated supine positioning nystagmus for the diagnosis of benign paroxysmal positional vertigo]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2017; 31 (09) 703-707 DOI: 10.13201/j.issn.1001-1781.2017.09.014.
- 42 Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T. et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngol Head Neck Surg. 2017; 156 (3_suppl) S1-s47 DOI: 10.1177/0194599816689667.
- 43 Yacovino DA, Hain TC, Gualtieri F. New therapeutic maneuver for anterior canal benign paroxysmal positional vertigo. J Neurol 2009; 256 (11) 1851-1855 DOI: 10.1007/s00415-009-5208-1.
- 44 Macdonald NK, Kaski D, Saman Y, Al-Shaikh Sulaiman A, Anwer A, Bamiou D-E. Central Positional Nystagmus: A Systematic Literature Review. Front Neurol 2017; 8 (141) 141 DOI: 10.3389/fneur.2017.00141.
- 45 Cohen HS. Side-lying as an alternative to the Dix-Hallpike test of the posterior canal. Otol Neurotol 2004; 25 (02) 130-134 DOI: 10.1097/00129492-200403000-00008.
- 46 Lynn S, Pool A, Rose D, Brey R, Suman V. Randomized trial of the canalith repositioning procedure. Otolaryngol Head Neck Surg 1995; 113 (06) 712-720 DOI: 10.1016/s0194-5998(95)70010-2.
- 47 Burton MJ, Eby TL, Rosenfeld RM. Extracts from the Cochrane Library: modifications of the Epley (canalith repositioning) maneuver for posterior canal benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 2012; 147 (03) 407-411 DOI: 10.1177/0194599812457134.
- 48 Maia RA, Diniz FL, Carlesse A. Treatment of benign paroxysmal positional vertigo with repositioning manevers. Rev Bras Otorrinolaringol 2001; 67 (05) DOI: 10.1590/S0034-72992001000500003.
- 49 Radtke A, von Brevern M, Tiel-Wilck K, Mainz-Perchalla A, Neuhauser H, Lempert T. Self-treatment of benign paroxysmal positional vertigo: Semont maneuver vs Epley procedure. Neurology 2004; 63 (01) 150-152 DOI: 10.1212/01.wnl.0000130250.62842.c9.
- 50 Bromwich MA, Parnes LS. The DizzyFix: initial results of a new dynamic visual device for the home treatment of benign paroxysmal positional vertigo. J Otolaryngol Head Neck Surg 2008; 37 (03) 380-387 DOI: 10.2310/7070.2008.0036.