Verti-Gone? Auditing the Spin on Hallpike Manoeuvre Documentation in Older Adults

Abstract Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder in older adults, affecting up to 50% of octogenarians (von Brevern et al., 2007). It is most often diagnosed using the Hallpike-Dix manoeuvre and treated with repositioning techniques like the Epley manoeuvre (Fife et al., 2008). BPPV significantly raises fall risk (Tinetti & Kumar, 2010). Falls impact the quality of life and independence of older adults; thus, vestibular assessment should be included as part of a comprehensive falls assessment (Montero-Odasso et al., 2022). A 5-year audit was conducted to assess vestibular assessment within a neuro-cardiovascular falls service at a tertiary hospital, focusing on the advantages of multi-canal assessment for improving diagnostic rates. Methods A retrospective audit was conducted of electronic patient records of patients who underwent a nurse-led vestibular assessment over a 5-year period between 2019 and 2024 in a specialist falls service. A total of 632 assessments were identified. Results Two hundred and seventy patients were diagnosed on Dix-Hallpike to have posterior canal BPPV, and 53 patients who proceeded to lateral canal testing following a negative Dix-Hallpike were diagnosed with horizontal canal BPPV, leading to a combined diagnostic yield of 51%. Successful resolution of nystagmus required 2-4 repositioning manoeuvres and a multi-canal diagnostic assessment. The addition of lateral canal testing improved the diagnostic yield by 8.3%, thus supporting its use in patients with negative Dix-Hallpike. Conclusion Given its high prevalence, recurrence, and impact on older adults, BPPV represents a significant public health concern requiring increased awareness and accurate diagnosis. Timely intervention can reduce its effects on mobility, fall risk, and overall well-being in this vulnerable population. Vestibular assessments should incorporate lateral canal testing alongside the Dix-Hallpike manoeuvre to improve diagnostic accuracy; our audit revealed nearly 1 in 10 cases were identified through lateral canal testing alone.