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Associate Professor. University Hospital Level 2, Rm 766. Stony Brook Medicine. Stony Brook, NY 11794-7025. Tel: (631) 444-2222. Fax: (631) 444-3419. Email: Roberta.Seidman@stonybrookmedicine.edu. Clinical Practice: Dr. Seidman is Board Certified in Neurology (1988) and Neuropathology (1990).
Dr. Roberta Seidman serves as the Director of Neuropathology for the Department of Pathology at Stony Brook Medicine. Dr. Seidman's neuropathology practice includes evaluation and diagnosis of a few hundred tumors of brain and spinal cord and other neurosurgical specimens each year, with a practice characterized by diagnostic excellence. Dr.
Dr. Roberta Seidman, MD is a board certified pathologist in Stony Brook, New York. She is currently licensed to practice medicine in New York. She is affiliated with Stony Brook University Hospital and is an Associate Professor at Stony Brook University SOM.
- Nicolls Rd, Stony Brook, 11794
Jun 1, 2022 · Robert J. Seidman is a novelist, an Emmy-winning screenwriter, and a literary critic. With Don Gifford, he is the co-author of Ulysses Annotated: Notes for James Joyce’s Ulysses. It Happened One Day in June. Why Ulysses is as vital as ever— compelling, complex, and direct. By Robert J. Seidman | Wednesday June 1, 2022.
- Guideline Purpose
- Action Statement Profile for Statement 1a
- STATEMENT 1b. DIAGNOSIS OF LATERAL (HORI-ZONTAL) SEMICIRCULAR CANAL BPPV: If the
- Action Statement Profile for Statement 1b
- STATEMENT 2a. DIFFERENTIAL DIAGNOSIS: Clini-
- STATEMENT 2b. MODIFYING FACTORS: Clinicians
- Action Statement Profile for Statement 2b
- STATEMENT 3a. RADIOGRAPHIC TESTING: Clini-
- Action Statement Profile for Statement 3a
- STATEMENT 3b. VESTIBULAR TESTING: Clinicians
- Action Statement Profile for Statement 3b
- STATEMENT 4a. REPOSITIONING PROCEDURES
- Action Statement Profile for Statement 4a
- STATEMENT 4b. POSTPROCEDURAL RESTRIC-
- Strong recommendation against restrictions based on RCTs
- Action Statement Profile for Statement 4b
- STATEMENT 4c. OBSERVATION AS INITIAL THER-
- The clinician may offer VR in the treatment of BPPV.
- Action Statement Profile for Statement 5
- STATEMENT 6. MEDICAL THERAPY: Clinicians
- Action Statement Profile for Statement 6
- STATEMENT 7a. OUTCOME ASSESSMENT: Clinicians
- Action Statement Profile for Statement 7a
- STATEMENT 7b. EVALUATION OF TREATMENT
- Action Statement Profile for Statement 7b
- Action Statement Profile for Statement 8
- Implementation Considerations
- Disclaimer
- Acknowledgments
- Author Contributions
- Disclosures
The primary purposes of this guideline are to improve quality of care and outcomes for BPPV by improving the accurate and efficient diagnosis of BPPV, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropri-ate use of ancillary testing such as radiographic imaging, and increasing the use of appropriate therap...
Quality improvement opportunity: Promoting accu- rate and efficient diagnosis of BPPV (National Quality Strategy domains: promoting effective pre-vention/treatments, affordable quality care) Aggregate evidence quality: Grade B based on diag- nostic studies with minor limitations Level of confidence in evidence: High Benefits: Improved diagnostic ac...
patient has a history compatible with BPPV and the Dix-Hallpike test exhibits horizontal or no nystagmus, the clinician should perform, or refer to a clinician who can perform, a supine roll test to assess for lateral semicircular canal BPPV. Recommendation based on diagnostic studies with limitations and a preponderance of benefit over harm.
Quality improvement opportunity: Improve accurate and efficient diagnosis of lateral canal BPPV (National Quality Strategy domains: promoting effective preven-tion/treatment, affordable quality care) Aggregate evidence quality: Grade B based on sev- eral RCTs with supine roll test as the reference entry standard Level of confidence in evidence: Hig...
cians should differentiate, or refer to a clinician who can differentiate, BPPV from other causes of imbalance, dizzi-ness, and vertigo. Recommendation based on observational studies and a preponderance of benefit over harm.
should assess patients with BPPV for factors that modify management, including impaired mobility or balance, CNS disorders, a lack of home support, and/or increased risk for falling. Recommendation based on observational and cross-sectional studies and a preponderance of benefit over harm.
Quality improvement opportunity: Decrease risks for complications from BPPV in at-risk populations (National Quality Strategy domains: safety, coordi-nation of care) Aggregate evidence quality: Grade C based on obser- vational and cross-sectional studies Level of confidence in evidence: Medium Benefits: Allow for management of patients with BPPV wi...
cians should not obtain radiographic imaging in a patient who meets diagnostic criteria for BPPV in the absence of additional signs and/or symptoms inconsistent with BPPV that warrant imaging. Recommendation against radio-graphic imaging based on diagnostic studies with limitations and a preponderance of benefit over harm.
Quality improvement opportunity: Reduce unneces- sary testing and costs, reduce unnecessary radiation and radiographic contrast exposure (National Qual-ity Strategy domains: safety, affordable quality care) Aggregate evidence quality: Grade C based on obser- vational studies for radiographic imaging Level of confidence in evidence: Medium Benefits:...
should not order vestibular testing in a patient who meets diagnostic criteria for BPPV in the absence of additional vestibular signs and/or symptoms inconsistent with BPPV that warrant testing. Recommendation against vestibular testing based on diagnostic studies with limitations and a pre-ponderance of benefit over harm.
Quality improvement opportunity: Reduce unnec- essary testing and costs (National Quality Strategy domains: safety, affordable quality care) Aggregate evidence quality: Grade C based on diag- nostic studies with limitations in referred patient populations and observational studies for vestibular testing Level of confidence in evidence: Medium Benef...
AS INITIAL THERAPY: Clinicians should treat, or refer to a clinician who can treat, patients with posterior canal BPPV with a CRP. Strong recommendation based on sys-tematic reviews of RCTs and a preponderance of benefit over harm.
Quality improvement opportunity: To promote effec- tive treatment of posterior canal BPPV (National Quality Strategy domain: promoting effective pre-vention/treatments) Aggregate evidence quality: Grade A based on sys- tematic reviews of RCTs Level of confidence in evidence: High for otolar- yngology or subspecialty settings, lower in primary care ...
TIONS: Clinicians should not recommend postprocedural postural restrictions after CRP for posterior canal BPPV.
with minor limitations and a preponderance of benefit over harm.
Quality improvement opportunity: Avoidance of unnecessary interventions, engaging patients, decreasing use of ineffective treatments (National Quality Strategy domain: coordination of care) Aggregate evidence quality: Grade A Level of confidence in evidence: High Benefits: Faster return to normal lifestyle, reduced anxiety, less sleep or work inter...
APY: Clinicians may offer observation with follow-up as initial management for patients with BPPV. Option based on data from cohort and observational studies with heteroge-neity and a relative balance of benefits and harms.
Option based on controlled observational studies and a bal-ance of benefit and harm.
Quality improvement opportunity: Offer additional therapy for patients with additional impairments, who fail initial CRP attempts, who are not candidates for CRP, and/or who refuse CRP. Promoting effec-tive therapy and increased patient safety (National Quality Strategy domains: safety, promoting effec-tive prevention/treatment) Aggregate evidence ...
should not routinely treat BPPV with vestibular suppres-sant medications such as antihistamines and/or benzodi-azepines. Recommendation against routine medication based on observational studies and a preponderance of benefit over harm.
Quality improvement opportunity: Decreased use of unnecessary medications with potentially harmful side effects; reduced costs (National Quality Strat-egy domains: safety, promoting effective prevention/ treatment, affordable quality care) Aggregate evidence quality: Grade C based on obser- vational and cross-sectional studies. Level of confidence ...
should reassess patients within 1 month after an initial period of observation or treatment to document resolu-tion or persistence of symptoms. Recommendation based on observational outcomes studies and expert opinion and a preponderance of benefit over harm.
Quality improvement opportunity: Obtain out- comes data for treatment of BPPV; ability to assess treatment effectiveness (National Quality Strategy domains: safety, engaging patients, coordination of care, promoting effective prevention/treatment) Aggregate evidence quality: Grade C studies with known significant failure rates for an observation op...
FAILURE: Clinicians should evaluate, or refer to a clini-cian who can evaluate, patients with persistent symptoms for unresolved BPPV and/or underlying peripheral ves-tibular or CNS disorders. Recommendation based on obser-vational studies of diagnostic outcomes in patients with BPPV and a preponderance of benefit over harm.
Quality improvement opportunity: Capture missed or erroneous diagnoses; offer retreatment to those patients with early recurrence of BPPV or failed ini-tial CRP (National Quality Strategy domain: safety, promoting effective prevention/treatment) Aggregate evidence quality: Grade A for treatment of observation failure and Grade B for CRP failure bas...
Quality improvement opportunity: Education allows patients to understand the implications of BPPV on quality of life and patient safety, especially falls (National Quality Strategy domains: safety, engaging patients, promoting effective prevention/treatment) Aggregate evidence quality: Grade C based on observational and cross-sectional studies of r...
Competing interests: Neil Bhattacharyya, Intersect ENT, Entellus, Sanofi—consultant; Jonathan A. Edlow, occasional medicolegal consulting; Michael D. Seidman, founder of Body Language Vitamins Co, royalties from ViSalus Sciences for products devel-oped, research funding (National Institutes of Health, Auris [non-compensated], MicroTransponder, Inc ...
Competing interests: Neil Bhattacharyya, Intersect ENT, Entellus, Sanofi—consultant; Jonathan A. Edlow, occasional medicolegal consulting; Michael D. Seidman, founder of Body Language Vitamins Co, royalties from ViSalus Sciences for products devel-oped, research funding (National Institutes of Health, Auris [non-compensated], MicroTransponder, Inc ...
Competing interests: Neil Bhattacharyya, Intersect ENT, Entellus, Sanofi—consultant; Jonathan A. Edlow, occasional medicolegal consulting; Michael D. Seidman, founder of Body Language Vitamins Co, royalties from ViSalus Sciences for products devel-oped, research funding (National Institutes of Health, Auris [non-compensated], MicroTransponder, Inc ...
Competing interests: Neil Bhattacharyya, Intersect ENT, Entellus, Sanofi—consultant; Jonathan A. Edlow, occasional medicolegal consulting; Michael D. Seidman, founder of Body Language Vitamins Co, royalties from ViSalus Sciences for products devel-oped, research funding (National Institutes of Health, Auris [non-compensated], MicroTransponder, Inc ...
Competing interests: Neil Bhattacharyya, Intersect ENT, Entellus, Sanofi—consultant; Jonathan A. Edlow, occasional medicolegal consulting; Michael D. Seidman, founder of Body Language Vitamins Co, royalties from ViSalus Sciences for products devel-oped, research funding (National Institutes of Health, Auris [non-compensated], MicroTransponder, Inc ...
Sep 14, 2010 · In this 2003 study by Seidman et al., Fischer rats were randomized into a treatment and control group. The treatment group was pretreated for 3 weeks with resveratrol solution (430/ug/kg/day) prior to a 24-hour exposure to a 105 dB noise at 4,500 to 9,000 Hz.
Our Providers: Division of Solid Tumor Oncology. As key members of Memorial Sloan Kettering’s disease management teams, physicians in the Division of Solid Tumor Oncology collaborate with other medical specialists to customize each patient’s treatment based on his or her individual disease.
