Persistent postural-perceptual dizziness: a functional neuro-otologic disorder
Reviewed by Praneta Kulloo

Persistent postural-perceptual dizziness (PPPD) is a neuro-otological disorder that is the most common cause of chronic vestibular syndrome. It is not a purely structural or psychiatric disease but a functional disorder. The authors reviewed the literature to summarise the diagnostic criteria, history, differential diagnoses, epidemiology, vestibular function test results, pathophysiological mechanisms and treatments for PPPD. PPPD is a chronic vestibular disorder characterised by vestibular symptoms of chronic dizziness, unsteadiness and non-spinning vertigo, lasting for more than three months, which are exacerbated by an upright posture or walking, motion and exposure to moving or complex stimuli. The Bárány Society has defined five criteria based on patient symptoms to make the diagnosis of PPPD. The average age of patients with PPPD is 49.2 years. They tend to be younger than those with uncompensated unilateral vestibular hypofunction. There is a female predominance in PPPD. PPPD usually follows a precipitating illness, including acute / episodic vestibular diseases or psychiatric conditions, such as panic attacks. The least common precipitants are chronic illnesses, such as neurodegenerative disorders. PPPD cannot be diagnosed by conventional vestibular tests. However, head roll-tilt subjective visual vertical test and gaze stability test after exposure to moving visual stimuli may detect the characteristic features of PPPD. That is, somatosensory and visually dependent spatial orientation, respectively. Neuroimaging studies suggest shifts in interactions among visuo-vestibular, sensorimotor, and emotional networks, where visual inputs dominate over vestibular inputs. Treatment of PPPD includes medications (selective serotonin reuptake inhibitors/serotonin noradrenaline reuptake inhibitors), vestibular rehabilitation, and cognitive behavioural therapy. As different professionals specialise in these treatments, multidisciplinary cooperation is necessary to provide a highly effective management of PPPD.

Persistent postural-perceptual dizziness: A functional neuro-otologic disorder.
Yagi C, Kimura A, Horii A.
AURIS NASUS LARYNX
2024;51(3):588–98.