Pathophysiology, Differential Diagnosis, and Management of Persistent Postural-Perceptual Dizziness: A Review

Purpose The purpose of this article is to review the advancing understanding, differential diagnosis, and integral role of vestibular rehabilitation (VR) in the relatively new but very common diagnosis, persistent postural-perceptual dizziness (PPPD). PPPD is a functional vestibular disorder characterized by chronic and persistent nonspinning dizziness, visual/motion hypersensitivities, and perceived unsteadiness that is often triggered from a definable peripheral vestibular disorder. PPPD is being found to be more common than many well-known peripheral vestibular disorders such as Ménière's disease or bilateral vestibular hypofunction. Early and correct identification of PPPD, including appropriately prescribed VR, is being found essential not only to promote optimal recovery but also to prevent more refractory engrained PPPD. Conclusion PPPD management is steadily advancing, and treating clinicians are now able to access internationally sanctioned diagnostic criteria, World Health Organization International Classification of Diseases , 11th Revision (WHO, 2018) classification, and advancing treatment protocols. Treatment protocols integrate not only medications and cognitive behavioral therapy but also the crucial role of VR, including education, visual/optokinetic motion desensitization, graded habitation, balance retraining, and integrated relaxation/mindfulness.