Risk Factors for Recurrence of Benign Paroxysmal Positional Vertigo. A Clinical Review.

Ioanna Sfakianaki,George Psillas,Petros Karkos,Grigorios G. Dimas,Paris Binos

doi:10.3390/jcm10194372

Abstract

Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular dysfunctions encountered in clinical practice. Although the treatment of BPPV is relatively successful, many patients develop recurrence after treatment. Our purpose is to evaluate the mean recurrence rate and risk factors of BPPV after treatment. A review of the literature on the risk factors of BPPV recurrence was performed. A thorough search was conducted using electronic databases, namely Pubmed, CINAHL, Academic Search Complete and Scopus for studies published from 2000 to 2020. Thirty studies were included in this review with 13,358 participants. The recurrence rate of BPPV ranged from 13.7% to 48% for studies with follow-up <1 year, and from 13.3% to 65% for studies with follow-up ≥2 years. Pathophysiologic mechanisms and implication of each of the following risk factors in the recurrence of BPPV were described: advanced age, female gender, Meniere’s disease, trauma, osteopenia or osteoporosis, vitamin D deficiency, diabetes mellitus, hypertension, hyperlipidemia, cardiovascular disease, migraine, bilateral/multicanal BPPV, cervical osteoarthrosis and sleep disorders. Patients with hyperlipidemia and hypertension had the highest recurrence rates of BPPV, 67.80% and 55.89%, respectively, indicating that vascular comorbidities increase the risk of BPPV recurrence. In addition, more than half of patients (53.48%) with diabetes mellitus and BPPV experienced recurrence of BPPV. Knowledge and awareness of risk factors for recurrence of BPPV are essential for the assessment and long-term prognosis of patients. Identification of these relapse risk factors may enhance the ability of clinicians to accurately counsel patients regarding BPPV and associated comorbidities.

Highlights

Benign paroxysmal positional vertigo (BPPV) is the commonest peripheral vestibular condition encountered in a neurotology clinic and it accounts for about 20% to 30% of all the vestibular complaints [1,2,3]
Our study showed that BPPV recurs in 39.44% of the cases that are comorbid with Meniere’s disease and in 34.81% of the posttraumatic cases of BPPV
Our intention was to avoid complex methods that in many cases are difficult to be interpreted by physicians and provide a clinical perspective on the recurrence of BPPV. This comprehensive review evaluated some possible risk factors for BPPV recurrence as there is no general consensus in the literature concerning their significance

Summary

Introduction

Benign paroxysmal positional vertigo (BPPV) is the commonest peripheral vestibular condition encountered in a neurotology clinic and it accounts for about 20% to 30% of all the vestibular complaints [1,2,3]. The mechanism of BPPV has been based on dislodged otoliths that leave the utricle and freely float in the semicircular canals or attach to the cupula, making the labyrinth sensitive to gravitational forces. BPPV is characterized by recurrent and brief vertigo with corresponding nystagmus when extending or turning the neck, getting up or lying down, or rolling over in bed. BPPV is idiopathic, and can be secondary Posterior semicircular canal involvement is the most common form in BPPV (90–91%), but lateral and anterior canals can be involved [7]

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