Dizziness is the most common reason for a visit to a primary care physician among the 65 and older patient population. This dizziness is often due to the presence of free floating particles (canaliths) in the vestibular system of the inner ear, which stimulates the sensory apparatus in the posterior semicircular canal and causes sudden severe sensations of vertigo when the head is turned in a certain direction. This condition of the posterior semicircular canal makes up 90% of cases and is classically referred to as Benign Paroxysmal Positional Vertigo (BPPV). Patients with BPPV are at increased risk for falls, a major cause of morbidity and mortality among the elderly. BPPV is easily treated with the Epley maneuver, or canalith repositioning maneuver, a sequence of head movements that work with gravity to allow the canaliths to move from the posterior semicircular canal back to the utricle of the inner ear where they do not disturb the sensory apparatus. In studies published in the medical literature, the Epley maneuver has an 80% or higher success rate in relieving BPPV. Despite the apparent simplicity of diagnosis and treatment of BPPV, it is rarely treated in the primary care setting. Instead, the patient is usually referred to a specialist or a sub specialist who then performs the Epley maneuver. As such, the patient copes with vertigo symptoms for several weeks until the appointment with the secondary or tertiary care provider. BPPV patients report estimated vertigo-related medical expenses of $2685 before receiving relief with the Epley maneuver. As such, a device that allows for accurate Epley maneuvers for the treatment of BPPV in the primary care setting would result in reduced healthcare costs as well as alleviate unnecessary suffering in BPPV patients. The proposed innovation, the Vertigone goggle, is a visual feedback device worn by the patient that allows the primary care physician to accurately guide the patient through the movements of the Epley maneuver. The goggle also contains a feedback mechanism for self-guided Epley maneuvers so that a patient prone to recurrent BPPV can perform the maneuver at home. In this Phase I SBIR research, a prospective single-blind cross-over study will establish the feasibility of the Vertigone goggle by demonstrating the effect of accuracy in performing the maneuver on clinical outcomes in BPPV patients. The overall goal of effort is to increase patient access to rapid treatment for BPPV by enabling primary care practitioners to accurately perform the maneuver. The Vertigone goggle will allow for BPPV to be treated in the primary care setting, rather than in the office of the specialist or subspecialist. This paradigm shift in the treatment of BPPV will result in reduced healthcare expenditures to treat BPPV and will largely eliminate unnecessary suffering in the BPPV patient population, as patients will no longer have to wait weeks or months for proper treatment.
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