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Is skull fracture associated with post-traumatic benign paroxysmal positional vertigo? An observational study
Abigail Newdick1, Bethany Kenny1, Lisa Fowler2
1St George's Hospital NHS Foundation Trust, Blackshaw Road, London, SW17 0QT, UK.
Injury
|August 30, 2025
Summary
Benign paroxysmal positional vertigo (BPPV) is common after acute traumatic brain injury (aTBI). Older age and combined facial and skull fractures increase BPPV risk in aTBI patients, necessitating routine screening.
Area of Science:
- Neuroscience
- Otolaryngology
- Trauma Surgery
Background:
- Vestibular dysfunction, including dizziness and imbalance, is a frequent consequence of acute traumatic brain injury (aTBI).
- Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder following aTBI.
- Post-traumatic BPPV often remains undiagnosed and untreated in aTBI patients.
Purpose of the Study:
- To identify clinical risk factors associated with the development of BPPV in individuals who have sustained an aTBI.
- To inform diagnostic and screening protocols for BPPV in the aTBI population.
Main Methods:
- A cohort of 166 patients with aTBI was recruited from three Major Trauma Centres in London.
- Logistic regression analysis was employed to determine the adjusted odds ratios (aOR) for diagnosed BPPV.
- Risk factors analyzed included sex, age categories, TBI severity, and the presence and location of skull fractures.
Main Results:
- Approximately one-third (33.1%) of aTBI patients were diagnosed with BPPV.
- Increased age was significantly associated with higher BPPV risk: patients aged 41-64 (aOR=3.86) and 65+ (aOR=4.41) had a greater likelihood of BPPV compared to those ≤40.
- Patients with combined facial and cranial skull fractures exhibited a substantially higher risk of BPPV (aOR=23.64) compared to those without skull fractures.
Conclusions:
- The risk of developing BPPV after aTBI escalates with advancing age.
- Combined facial and skull fractures represent a significant risk factor for post-traumatic BPPV.
- Routine screening for BPPV is recommended for all aTBI patients, with particular emphasis on older adults and those with combined facial and skull fractures.
