Comparison between objective and subjective benign paroxysmal positional vertigo: clinical features and outcomes

Area of Science:

• Neurology
• Otolaryngology
• Vestibular Disorders

Background:

• Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder.
• Differentiating objective BPPV (O-BPPV) from subjective BPPV (S-BPPV) is important for treatment.
• Canalith repositioning maneuvers (CRMs) are a standard treatment for BPPV.

Purpose of the Study:

• To compare demographic and clinical characteristics between O-BPPV and S-BPPV.
• To evaluate treatment outcomes, including response to CRMs and recurrence rates, for both O-BPPV and S-BPPV.
• To determine if CRMs are effective for S-BPPV, even in the absence of observable nystagmus.

Main Methods:

• Retrospective review of 134 BPPV patient records.
• Categorization into O-BPPV (vertigo, autonomic symptoms, nystagmus) and S-BPPV (symptoms without nystagmus during maneuvers).
• Analysis of demographics, medical history, symptoms, CRM response, time to treatment, and 3-year recurrence rates.

Main Results:

• No significant differences in demographics, past medical history, or associated symptoms between O-BPPV and S-BPPV.
• Posterior canal BPPV was more prevalent in S-BPPV, while both canals were similarly affected in O-BPPV.
• No significant differences in CRM effectiveness, maneuvers required, or time to first visit; recurrence rates were 13.8% for O-BPPV and 21.2% for S-BPPV.

Conclusions:

• O-BPPV and S-BPPV exhibit similar patient profiles and clinical presentations.
• CRMs demonstrate efficacy in treating S-BPPV, irrespective of observed nystagmus.
• CRMs should be considered the primary therapeutic approach for S-BPPV.