Persistent postural-perceptual dizziness (PPPD) is a chronic vestibular disorder characterized by non-vertiginous dizziness or unsteadiness lasting three months or more. Symptoms are present most days and worsen with upright posture, motion, or visually complex environments (e.g., moving through a grocery store aisle).

Patients commonly describe swaying or rocking sensations that fluctuate in intensity and may last hours.

PPPD often develops following an acute vestibular event such as BPPV, vestibular neuritis, vestibular migraine, Meniere's disease, concussion, dysautonomia, stroke, or periods of heightened stress. Although the initial condition improves, the brain does not fully recalibrate balance processing.

Persistent visual over-reliance and heightened postural threat monitoring can perpetuate chronic dizziness. Anxiety and hypervigilance may amplify symptoms but are not considered the primary cause.

Vestibular testing is frequently normal or reveals findings insufficient to explain symptom severity. Physical examination, laboratory studies, and neuroimaging are not diagnostic of PPPD but are useful in identifying alternative or comorbid conditions. Management for PPPD is multidisciplinary.

Vestibular rehabilitation is primary; cognitive behavioral therapy (CBT) and pharmacologic management (e.g., SSRIs/SNRIs) may be considered when symptoms are persistent or significantly impairing.

Have You Heard The News?

In this 2020 study, outcomes from a tertiary-care multimodal day-treatment program for patients with chronic dizziness (including PPPD) were evaluated.

Out of the 657 patients analyzed, 305 met diagnostic criteria for PPPD. The program combined vestibular rehabilitation, cognitive behavioral therapy, and pharmacologic management.

Treatment effectiveness was assessed using validated patient-reported outcome measures, including the Vertigo Severity Scale (VSS) to quantify vertigo and dizziness symptoms, with vestibular-balance (VSS-V) and autonomic-anxiety (VSS-A) subscales, and the Hospital Anxiety and Depression Scale (HADS) to screen for anxiety and depression. These questionnaires were administered pre- and post-intervention.

Following treatment, all patients demonstrated significant improvements in VSS scores, HADS anxiety, symptom intensity, and distress. Patients meeting PPPD criteria generally showed a tendency toward greater improvement compared to patients with other chronic dizziness diagnoses, with a statistically significant between-group difference observed in the VSS-A subscale.

These findings support a multimodal approach that addresses both vestibular and behavioral components of persistent dizziness.

Source: Hubertus, A., Finn, S., Wassermann, A., Guntinas-Lichius, O., Klingner, C., & Witte, O. (2020). Multimodal treatment of persistent postural-perceptual dizziness. Brain and Behavior, 2020;10(12), 1-10.

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That's A Fact!

PPPD is a relatively recent diagnostic entity, with standardized criteria established by The Bárány Society in 2017.

Take the First Step Toward Steady Ground

If you are experiencing persistent dizziness, swaying, or unsteadiness, you don't have to navigate it alone. Our experienced team at Audiology Associates is here to help you understand your symptoms and find clear answers.

Schedule a comprehensive balance test with us today to get back to feeling steady and confident in your daily life.