The Patterns of Recurrences in Idiopathic Benign Paroxysmal Positional Vertigo and Self-treatment Evaluation

Benign paroxysmal positional vertigo (BPPV) recurs frequently. This study aims to determine that each patient with BPPV has a predilection for a specific canal and the type of recurred BPPV can be predicted from that observed during the previous attack.

The involved side (right, left, and bilateral) and affected canal (posterior, geotropic horizontal, apogeotropic horizontal, anterior, and mixed) were analyzed in 224 pairs of consecutive attacks of BPPV confirmed in 167 patients at the Dizziness Clinic of Seoul National Bundang Hospital from 2003 to 2017. We defined the recurrence when patients had the redevelopment of BPPV at least 1 week after resolution of the previous one.

During the initial attack, the involved canals were posterior in 134 (59.8%), geotropic horizontal in 53 (23.7%), apogeotropic horizontal in 27 (12.1%), anterior in 5 (2.2%), and mixed in 5 (2.2%). The right ear was more commonly affected than the left ear [132 (58.9%) vs. 90 (40.2%)]. Two patients (0.9%) showed bilateral involvements. During the recurrences, the proportions of involved canals and affected side were similar irrespective of those during the former event. Only 24% of the patients showed the recurrence in the same canal on the same side.

The patterns of recurrences are usually discordant in patients with BPPV. Instruction for self-administration of a specific canalith repositioning procedure based on the previous type of BPPV may have a limited efficacy in this frequently recurrent disorder.