Benign Paroxysmal Positional Vertigo in the Elderly: A Single-center Experience

Area of Science:

• Geriatric Medicine
• Neurology
• Otolaryngology

Background:

• Dizziness and balance issues are prevalent in the elderly.
• Benign paroxysmal positional vertigo (BPPV) is a frequent cause of dizziness in older adults.
• Understanding BPPV subtype distribution and treatment efficacy in the elderly is crucial for effective management.

Purpose of the Study:

• To investigate the subtype distribution of BPPV in elderly patients.
• To compare the treatment efficacy of canalith repositioning maneuvers (CRM) across different BPPV subtypes in this demographic.
• To identify potential reasons for observed differences in treatment outcomes.

Main Methods:

• Retrospective study conducted at a tertiary referral academic center.
• Inclusion of 316 elderly patients diagnosed with BPPV between March 2013 and March 2019.
• Diagnosis of BPPV subtypes using head-roll and Dix-Hallpike tests, followed by CRM treatment.

Main Results:

• Posterior semicircular canal BPPV occurred in 45% of patients, LSCC canalolithiasis in 15%, and LSCC cupulolithiasis in 40%.
• Treatment success after one CRM session was 66% for posterior canal BPPV, 63% for LSCC canalolithiasis, and only 32% for LSCC cupulolithiasis.
• A single case of anterior semicircular canal BPPV was identified.

Conclusions:

• LSCC cupulolithiasis is disproportionately common in the elderly BPPV population.
• CRM treatment efficacy is significantly lower for LSCC cupulolithiasis compared to other BPPV subtypes.
• The higher prevalence and lower treatment success of LSCC cupulolithiasis in the elderly may relate to delayed presentation or unique pathophysiology.