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Persistent Postural-Perceptual Dizziness—A Systematic Review of the Literature for the Balance Specialist

Trinidade, Aaron*; Goebel, Joel A.

doi: 10.1097/MAO.0000000000002010

Objective: To present a systematic review of the current data on persistent postural-perceptual dizziness (PPPD), a useful and relatively new diagnosis for a disorder that has previously been known by many different names. In addition, to discuss diagnostic criteria and management strategies for this condition with the otologist in mind.

Data Sources: CINAHL, Embase, PubMed, Medline, PsycINFO, PubMed, Google Scholar.

Review Method: The phrase “persistent postural-perceptual dizziness” and its acronym “PPPD” were used.

Results: From 318 articles, 15 were selected for full analysis with respect to PPPD. Most were case-control studies, with one consensus paper from the Bárány Society available. Overall, the pathophysiology of PPPD remains relatively poorly understood, but is likely to be a maladaptive state to a variety of insults, including vestibular dysfunction and not a structural or psychiatric one. Cognitive behavioral therapy, vestibular rehabilitation, selective serotonin uptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs) all seem to have a role in its management.

Conclusions: PPPD is useful as a diagnosis for those treating dizziness as it helps to define a conglomeration of symptoms that can seem otherwise vague and allows for more structured management plans in those suffering from it.

*Southend University Hospital NHS Foundation Trust, Prittlewell Chase, Westcliff-on-Sea, UK

Washington University in St. Louis School of Medicine, St. Louis, Missouri

Address correspondence and reprint requests to Aaron Trinidade, F.R.C.S. (ORL-HNS), Department of Otolaryngology, Southend University Hospital NHS Foundation Trust, Prittlewell Chase, Westcliff-on-Sea, UK; E-mail:

There were no sources of support that require acknowledgment; no funding was received for this work from any organizations.

The authors disclose no conflicts of interest.

Copyright © 2018 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company