xRead - Episodic Vertigo (January 2026)

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Otolaryngology–Head and Neck Surgery 162(2S)

Aggregate evidence quality: Grade C, single RCT evaluating a patient education booklet and the con siderable literature on shared decision making Level of confidence in evidence: High Benefits: Patient engagement, patient satisfaction, improved adherence to treatment, avoidance of unnecessary treatments, more optimal use of health care resources, improved symptom control, improved shared decision making Risk, harm, cost: Time for education, patient dis tress, diagnosis uncertainty Benefit-harm assessment: Preponderance of benefit over harm Value judgments: Education allows for improved shared decision making. This assumes that the patient is not already appropriately educated. Intentional vagueness: None Role of patient preferences: Small, but patients may express preference for optimal method of education Exclusions: None Supporting Text The purpose of this statement is to affirm the importance of shared decision making when diagnosing, caring for, and managing patients with MD. Clinicians are encouraged to engage and educate patients about MD, with information that is clearly understandable and relevant to the disorder. Clinicians should take the time to explain MD and treatment options. When there is open patient-clinician communica tion and when education is provided about health outcomes and treatment options, patients are empowered to make informed decisions, adhere to treatment plans, and have greater satisfaction and better outcomes. 189-191 Clinicians should inform patients about MD, symptoms of the condition, and ways to manage those symptoms. Education should include lifestyle modifications, dietary restrictions, anticipated diagnostic testing, and treatment options. Long-term effects of the disease, which include hearing loss, vestibular/balance problems, and tinnitus, should also be discussed. Treatment options should be explained to the patient, with risks and benefits of each option. Before considering highly invasive and ablative sur gical procedures such as a labyrinthectomy, patients should be informed that MD does affect the contralateral ear in some patients, which could leave the patient without mean ingful hearing or vestibular function. Education should be provided both verbally and in handouts, when available, written at a level that the patient can readily comprehend ( Table 8 ). Sufficient time should be allowed for patient questions and answers, to promote shared decision making. In clinical studies, time constraints were one of the most cited barriers in implementing shared decision making in clinical practices. 192 However, shared decision making is Policy level: Recommendation Differences of opinion: None

supported by evidence from 86 RCTs showing knowledge gained by patients, more confidence in decisions, and more active patient involvement. 193 Allowing the appropriate time to educate the patient will not only provide patients with the necessary tools to equally participate in their health plans but will also build trust, providing a better patient clinician relationship. In patients with MD, there is only 1 RCT supporting the benefit of patient education. This RCT looked at the effec tiveness of booklet-based education to manage symptoms of MD. Patients were randomized to 3 groups: a waiting-list control group, a vestibular rehabilitation (VR) group, and a symptom control group. The Vestibular Rehab booklet was designed to promote exercises to help in the recovery from symptoms. The Symptom Control booklet was geared toward helping the patient reduce stress that can exacerbate the symptoms of MD. Both the VR and symptom control groups showed statistically significant improvements in terms of reduced handicap, which was measured at 3 and 6 months after baseline, according to the Dizziness Handicap Inventory (DHI). The VR group showed additional improve ments in reduced symptoms, anxiety, and negative beliefs about dizziness. 194 These results demonstrate a definite ben efit to providing patients with the necessary information to help in self-management. Incorporating patients’ values and beliefs into the decision making process increases their participation, improves patient well-being, and results in better adherence to treatment with fewer concerns about illness and higher patient satisfaction. 195 Ways to implement this process involve Providing clear, appropriate, and understandable information regarding MD, symptomatology, life style modifications, diagnostic testing, long-term risks of the condition, and psychological impact of the disease. Discussing treatment options that include diet and lifestyle modifications, medications, IT injections, or potential surgical treatment options. With each treat ment option, risks and benefits should be explained in detail. Eliciting patient values, concerns, and psychological needs when treating and managing MD. Encouraging patients to reach out to support groups if indicated. Reaching a patient-clinician consensus on an indivi dualized treatment plan. Building a patient-clinician partnership with open communication. Encouraging patients to keep jour nals of symptoms, triggers, and alleviating factors, as well as stressing the importance of continued follow-up. Patients are often stressed and anxious when they are unwell and suffer from a chronic condition. As such, patients may not be able to integrate all the information pro vided to them in a single consultation and may need to