When Particle Repositioning Maneuvers Just Will Not Stick: Clinical Considerations for Persistent Benign Paroxysmal...

Area of Science:

• Neurology
• Otolaryngology
• Vestibular Disorders

Background:

• Benign paroxysmal positional vertigo (BPPV) is typically manageable, but persistent cases present diagnostic and therapeutic challenges.
• Differential diagnosis is crucial to exclude central, vascular, or cervical etiologies mimicking persistent BPPV.
• Noninvasive treatment options are vital for BPPV refractory to standard particle repositioning maneuvers (PRMs).

Observation:

• A case study of a 68-year-old male with persistent posterior semicircular canal BPPV (PC-BPPV) unresponsive to multiple PRMs is presented.
• Clinical presentation was analyzed alongside potential differential diagnoses to identify the most probable cause.
• The review focuses on nonsurgical treatments for intractable PC-BPPV.

Findings:

• BPPV resistant to PRMs necessitates investigation into alternative etiologies.
• Key historical and examination findings aid in differentiating persistent BPPV from other conditions.
• Brandt-Daroff exercises show potential for symptom habituation in persistent BPPV.

Implications:

• Persistent BPPV management requires a comprehensive diagnostic approach.
• Brandt-Daroff exercises offer a viable non-PRM treatment option.
• Further research is needed on advanced treatments like multiaxial repositioning chairs for intractable BPPV.