Research in Vestibular Science

Original Articles

Clinical Characteristics of Recurrent Benign Paroxysmal Positional Vertigo: A Retrospective Cohort Study: Jae-Myung Kim, Bang-Hoon Cho, Jong-Kyung Lee, Myeong-Kyu Kim, Seung-Han Lee; Res Vestib Sci. 2021;20(2):45-50. Published online June 14, 2021; DOI: https://doi.org/10.21790/rvs.2021.20.2.45

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Abstract PDF Supplementary Material: Objectives
Benign paroxysmal positional vertigo (BPPV) is a potentially recurrent disease even after successful canalith repositioning maneuvers. However, the exact recurrence rate or any clinical factors affecting the recurrence of BPPV still need to be elucidated.
Methods
We recruited patients diagnosed as BPPV in a tertiary hospital for 3 years. We retrospectively reviewed the clinical information of the patients including baseline demographics, comorbidities and predisposing factors through the electronic medical records. We performed a telephone survey or direct interview 3 to 6 years later from the initial diagnosis of BPPV was made. To determine the factors associated with the recurrence, we divided study population into two subgroups; ‘recurrence group’ vs. ‘recurrence-free group.’ Then, intergroup comparative analyses were performed.
Results
Among 397 patients who were originally eligible for the study, we performed a telephone survey or direct interview in 289 patients (72.8%) to determine the recurrence of BPPV. The overall recurrence rate was 29.4% (85 of 289). Baseline demographics except female gender (p=0.014) were not different between subgroups. Neither clinical characteristics nor vascular comorbidities were associated with the recurrence. However, patients with low bone mineral density (BMD; T-score below ‒1, osteopenia/osteoporosis) showed significantly higher recurrence than those with normal BMD (40.6% vs. 0%, p=0.009).
Conclusions
Female gender and low BMD (T-score below ‒1) were associated with the recurrence of BPPV in this study. Further researches in various clinical settings with larger sample size are warranted to identify the factors affecting the relapse of BPPV.

The Influence of Sleep Position on Benign Paroxysmal Positional Vertigo: Yong Gook Shin, Jin Woo Park, Ja Won Gu, Mee Hyun Song, Dae Bo Shim; Res Vestib Sci. 2016;15(4):121-125. Published online December 12, 2016; DOI: https://doi.org/10.21790/rvs.2016.15.4.121

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Abstract PDF: Objective: The purpose of this study was to identify the influence of sleep position on benign paroxysmal positional vertigo (BPPV).
Methods
Four hundred sixty patients diagnosed as posterior or horizontal canal BPPV were analyzed retrospectively. All patients were asked about their preferred sleep positions among the following four choices: supine, right or left lateral, or no predominant side via questionnaire at initial visit and after 1month. Patients were classified into two groups: affected side group meaning that the patient preferred to sleep ipsilateral to the affected ear and other position group including all positions other than lying lateral to the affected side after treatment. We analyzed the change in the sleep pattern after treatment and compared the recurrence rate between the two groups.
Results
Our study included 244 patients with posterior canal BPPV (PC-BPPV) and 216 patients with horizontal canal BPPV (HC-BPPV). Statistically significant correlation was demonstrated between sleep position side and the affected side by BPPV. The number of patients who slept on the affected side by BPPV decreased, while the number of patients who slept on the healthy side increased significantly after treatment. There was no statistically significant difference in the recurrence rate between the two groups.
Conclusion
There was significant correlation between the sleep position side and the affected side in PC-BPPV and HC-BPPV. The patient had a tendency to avoid lying lateral to the affected side by BPPV during sleep after treatment, however the change in sleep position did not influence the recurrence rate of BPPV.

Review

Updates in Intractable Benign Paroxysmal Positioning Vertigo: Yoon Gi Choi, Young Joo Ko, Hyun Ji Kim, Kyu Sung Kim; Res Vestib Sci. 2016;15(2):39-43. Published online June 15, 2016

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Abstract PDF: Benign paroxysmal positioning vertigo (BPPV) is the most common disease that causes dizziness which is usually resolved spontaneously or by office-based physical therapy. However, clinicians sometimes encounter atypical or intractable BPPV cases which show poor effect with physical therapy including canalith reposition therapy and liberative maneuvers and frequent recurrence. There is no common definition, diagnosis and treatment protocols for intractable BPPV. Various types of intractable BPPV and reported treatment methods are discussed in this review.

Original Articles

Long-Term Outcomes of Canalith Repositioning for Benign Paroxysmal Positional Vertigo: Kaplan-Meier Estimate: Gu Il Rhim; Res Vestib Sci. 2016;15(1):17-21.

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Abstract PDF: Objective: The objective of this study is to determine the long-term recurrence rate of benign paroxysmal positional vertigo (BPPV) and the factors associated to such recurrence.
Methods
Retrospective review was performed for 295 patients diagnosed as idiopathic BPPV. After successful resolution by particle repositioning maneuver, all patients were followed up by visiting clinic or telephone. A study period was 1?56 months and average follow up period for study population after the initial treatment was 26 months. The rate of recurrence was estimated according to the
method
of Kaplan-Meier and compared by the log-rank test.
Results
Overall recurrence rate by Kaplan-Meier estimate was 50% at 30 months. Kaplan-Meier estimate suggests the effect of patient age, sex and visit of treatment sessions in initial episode on BPPV recurrence over 3 year follow-up period. Recurrent rate was significantly higher in patients aged 40 years or older (p＜0.013) and in patients with three or more visit of treatment sessions (p＜0.015). However, there was no significant association between recurrence rate and sex.
Conclusion
The long-term recurrence of BPPV was associated with age above 40 years and the number of visit for treatment sessions. This finding suggests that the recurrence of BPPV may be related with aging process.

Relationship Between Clinical Features and Recurrence in Benign Paroxysmal Positional Vertigo of Posterior Semicircular Canal: Ji Yun Park, Tae Kyeong Lee, Du Shin Jeong, Ki Bum Sung; Res Vestib Sci. 2011;10(2):63-67.

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Abstract PDF: Background and Objectives: The aim of this study is to evaluate the relationship between the recurrence and clinical features of posterior canal benign paroxysmal positional vertigo (p-BPPV). Materials and Methods: Eighty one consecutive patients with p-BPPV in 1 year period were selected and traced for 2 years by telephone interview and chart review. We reviewed the clinical chart to confirm the lesional side of semicircular canals when 13 patients of the recurrent groups had readmitted. We compared clinical characters between the recurrent group and the nonrecurrent group. Results: The recurrence rate after the successful treatment in the p-BPPV is 28% (23/81) patients. There was no difference in the age, sex, and days prior to visit between the recurrent group and the nonrecurrent group (72%, 58/81). The interval to recurrences were ranged from 8 days to 24 months. In the patients we could confirm the side of recurrences (13/23), there was a tendency of recurring on the same side in the early recurrences (within 14 days) (4/13). Conclusion: In considering the causes, the fact that early recurrences tend to be on the same side may be related to unilateral otolith dysfunction as the cause of recurrences in p-BPPV. But the late recurrence may be related to systemic condition because recurrent BPPV developed equally on both sides.

Clinical Study of Benign Paroxysmal Positional Vertigo: Chang Hee Bae, In Hyo Lee, Dong Yook Park, Jung Eun Kim, Hyuk Soon Chang, Dong Wook Kim; Res Vestib Sci. 2010;9(3):93-99.

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Abstract PDF: Background and Objectives: Benign paroxysmal positional vertigo (BPPV) was the most frequent peripheral type vertigo. It has been well controlled with canalith repositioning procedure. Canalith repositioning procedure provides rapid and long-lasting relief of symptoms in most patients with BPPV. However, some patients express nonspecific symptoms such as anxiety or discomfort after canalith repositioning procedure, even after the disappearance of nystagmus and vertigo. The purpose of this study is to assess type distribution of BPPV and relationship between recurrence and subjective residual dizziness after canalith repositioning procedure in patients. Materials and Methods: Ninety-five BPPV patients of 501 patients with dizziness who visited Dizziness Clinic in the Department of Otolaryngology at Soonchunhyang University Hospital from July 2005 to June 2008 were included in this study. These patients were retrospectively reviewed based on clinical charts. In the case of BPPV, repositioning procedure was performed. We analyzed the recurrence, the relationship between recurrence and subjective residual dizziness after canalith repositioning procedure. Results: Overall recurrence rate was 13.6%. Lateral canal origin was more common than posterior canal origin. All cases except 1 were recovered by canalith repositioning procedure. There was no correlation between recurrence and origin, type, subjective residual dizziness of patients. Conclusion: Patients showed various origin, type and recurrence. After the successful canalith repositioning procedure, residual subjective symptoms of patients were presented sometimes, but was no relation to recurrence. Thus, additional follow up and emotional management may be needed.

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