Analysis of factors affecting the recurrence of benign paroxysmal positional vertigo in elderly patients

Abstract

Objective To analyze factors for the recurrence of benign paroxysmal positional vertigo (BPPV) in the elderly. Methods A total of 59 elderly patients with BPPV who received diagnosis and treatment at our hospital, and experienced recurrence during a 24-month follow-up were selected as the recurrent group and 59 elderly patients without BPPV recurrence after treatment were randomly selected as the non-recurrent group. Factors, including age, gender, semicircular canal involvement, precipitating factors, time of recurrence, magnetic resonance imaging of the head, hypertension, diabetes mellitus, hyperlipidemia, posterior circulation ischemia, and obstructive sleep apnea-hypopnea syndrome (OSAHS), were compared between the two groups, and their relevance to BPPV recurrence was analyzed using binary logistic regression. Results The peak time of recurrence was 6-9 months after initial recovery. Posterior semicircular canal involvement was common in both groups at the onset of BPPV and there was no significant difference (χ2=6.318, P=0.097). In the recurrent group, recurrence affected the same semicircular canal in 31 patients (52.5%), a different semicircular canal on the same side in 16 patients (27.1%), and semicircular canals on the opposite side or both sides in 12 patients (20.3%). Possible precipitating factors for BPPV recurrence included insomnia, psychological factors, fatigue, migraine, upper respiratory infection and cough, with the first two showing the strongest association (χ2=4.933, P=0.026). The combination of hyperlipidemia and posterior circulation ischemia increased the risk for BPPV recurrence (OR=5.822, 95% CI: 2.317-14.629, P=0.000; OR=1.078, 95% CI: 1.044-8.267, P=0.041). The incidence of lacunar infarction was significantly higher in the recurrent group than in the non-recurrent group (χ2=5.446, P=0.020), and the infarcts were more often found in the frontal lobe (χ2=4.259, P=0.039) and the parietal lobe (χ2=8.859, P=0.003), indicating that arteriolar sclerosis or occlusion might be a cause for BPPV recurrence. Patients generally visited the neurology or emergency medicine department at the initial episode and the first recurrence, but were usually referred to the otorhinolaryngology department without much delay in later recurrent episodes. Conclusions BPPV recurrence can be reduced by instituting social and psychological intervention and by mitigating precipitating factors. It is of great significance to control blood lipid levels effectively, improve posterior circulation ischemia and take targeted interventions in order to prevent BPPV recurrence in the elderly. Key words: Benign paroxysmal positional vertigo; Recurrence; Precipitating factor