• Clinical science

Persistent postural-perceptual dizziness (Phobic postural vertigo)

Summary

Persistent postural-perceptual dizziness (PPPD), originally known as phobic postural vertigo (PPV), is an idiopathic disorder that presents with a persistent sensation of non-rotational dizziness or unsteadiness and hypersensitivity to motion, lasting at least 3 months. It is the most common cause of chronic dizziness and it often follows an event that caused acute vertigo or dizziness, such as vestibular neuritis or panic attacks. Typically, patients recover from the initial acute disease, but the feeling of dizziness persists. Treatment consists of vestibular rehabilitation, psychotherapy and, if necessary, SSRIs.

Epidemiology

  • Most common vestibular disorder in people 30–50 years of age

References:[1]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

References:[2][1][3]

Clinical features

  • Persistent sensation of non-rotational dizziness or unsteadiness for at least 3 months
    • Symptoms are present ≥ 15 of every 30 days, although most patients experience daily symptoms
    • Dizziness typically worsens with motion of both the patient and his or her surroundings
  • PPPD patients often suffer from anxiety and/or depressive disorders

References:[2][1][3]

Diagnostics

  • PPPD is a clinical diagnosis
  • History of an initial event and waxing and waning dizziness, nonspinning vertigo, and unsteadiness for at least 3 months.
  • Physical examination is usually unremarkable

References:[3][4]

Differential diagnoses

See differential diagnoses for vertigo

The differential diagnoses listed here are not exhaustive.

Treatment

The following measures are indicated for all patients:

References:[2][3]

Prognosis

The majority of patients recover completely or improve considerably.

References:[2][1][3][5]

  • 1. Holle D, Schulte-Steinberg B, Wurthmann S et al. Persistent postural-perceptual dizziness: a matter of higher, central dysfunction?. PLoS One . 2015; 10(11). doi: 10.1371/journal.pone.0142468.
  • 2. Saraiva R, Bittara M, von Söhsten Lins EMD. Clinical characteristics of patients with persistent postural-perceptual dizziness. Brazilian Journal of Otorhinolaryngology. 2015; 81(3): pp. 276–282. doi: 10.1016/j.bjorl.2014.08.012.
  • 3. Vestibular Disorders Association. Persistent Postural-Perceptual Dizziness. https://vestibular.org/pppd. Accessed May 23, 2017.
  • 4. Popkirov S, Staab J. Persistent postural-perceptual dizziness (PPPD): a common, characteristic and treatable cause of chronic dizziness. Practical Neurology. 2017. url: https://pn.bmj.com/content/18/1/5​​​​​​​.
  • 5. Pollak L, Klein C, Stryjer R, Kushnir M, Teitler J, Flechter S. Phobic postural vertigo: a new proposed entity. IMAJ. 2003; 5. url: https://www.ima.org.il/filesupload/imaj/0/54/27309.pdf.
last updated 07/09/2020
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