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Otol Neurotol. 2018 Dec;39(10):1291-1303. doi: 10.1097/MAO.0000000000002010.

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

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Southend University Hospital NHS Foundation Trust, Prittlewell Chase, Westcliff-on-Sea, UK.
Washington University in St. Louis School of Medicine, St. Louis, Missouri.



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.


CINAHL, Embase, PubMed, Medline, PsycINFO, PubMed, Google Scholar.


The phrase "persistent postural-perceptual dizziness" and its acronym "PPPD" were used.


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.


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.

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