Persistent postural-perceptual dizziness—a systematic review of the literature for the balance specialist

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. Key Words: Dizziness—Functional dizziness—Persistent postural-perceptual dizziness.