Why do treatment failure and recurrences of benign paroxysmal positional vertigo occur?
OBJECTIVE
To investigate the potential risk factors associated to the treatment failure and recurrence of benign paroxysmal positional vertigo (BPPV).


METHODS
Prospective cohort study.


METHODS
Tertiary referral center.


METHODS
Four hundred patients with benign paroxysmal positional vertigo, 119 men and 281 women, aged 27 to 88 years.


METHODS
Patients were treated once a week, with only one, appropriate, depending on the affected canal, repositioning maneuver (modified Epley, Semont, barbecue/inverted Gufoni, Kim). The control Dix-Hallpike test and the roll test were performed on 7 days.


METHODS
The treatment outcome and recurrence were evaluated with regard to sex, age, duration of symptoms, etiologic factors, migraines, osteoporosis, vascular risk factors, endocrine diseases, localization of otoconia, and simultaneous involvement of multiple canals.


RESULTS
The results indicate that treatment was negatively affected by patients' age, osteoporosis, and head trauma, without them causing recurrent symptoms. The highest number of uncured patients was observed in the 73- to 88-year-old age group (14.8%). The application of more than one maneuver was necessary in 27.5% of cases with primary BPPV and 88.9% with secondary BPPV. The highest treatment success was achieved in the group with BPPV of the posterior semicircular canal (F = 3.668, p = 0.026). The recurrence rate was 15.5%.


CONCLUSIONS
Potential risk factors associated to the treatment failure were as follows: the age older than 50, secondary BPPV, head trauma, the occurrence of osteoporosis, and localization of otoconia in the anterior semicircular canal. The analyzed factors did not have impact on the recurrence.
*ENT Clinic, Clinical and Hospital Center "Zvezdara"; †Medical School University of Belgrade, Clinic for Otorhinolaryngology and Maxillofacial Surgery; and ‡University of Belgrade School of Medicine, Clinic for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Republic of Serbia.
Snezana
S
Babac
Dragoslava
D
Djeric
Mirjana
M
Petrovic-Lazic
Nenad
N
Arsovic
Aleksandar
A
Mikic
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065635:Benign Paroxysmal Positional Vertigo / Q000453:epidemiology* / Q000628:therapy*; D006259:Craniocerebral Trauma / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology; D010037:Otolithic Membrane; D011187:Posture; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012665:Semicircular Canals; D016896:Treatment Outcome