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Revisiting BPPV: Incidence and Behavior of Atypical Variants
Salvatore Martellucci1, Andrea Castellucci2, Pasquale Malara3
1ENT Unit, Santa Maria Goretti Hospital, AUSL Latina, 04100 Latina, Italy.
Audiology Research
|October 28, 2025
Summary
Atypical forms of benign paroxysmal positional vertigo (BPPV) are more common in specialized centers than previously thought. These cases require more treatment sessions and maneuvers for symptom resolution compared to typical BPPV.
Area of Science:
- Otolaryngology
- Neurology
- Vestibular Disorders
Background:
- Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder.
- Atypical BPPV presentations can exhibit unique signs, symptoms, and variable treatment responses.
- Understanding atypical BPPV is crucial for accurate diagnosis and effective management.
Purpose of the Study:
- To determine the incidence of atypical BPPV compared to typical BPPV.
- To describe the clinical behavior and characteristics of atypical BPPV.
- To compare treatment outcomes between typical and atypical BPPV cases.
Main Methods:
- Retrospective analysis of clinical and instrumental data from 139 patients over 12 months.
- Patients categorized into "typical" unilateral labyrintholithiasis (Group A) and "atypical" forms (Group B).
- Comparison of treatment sessions, maneuvers, and resolution times between groups.
Main Results:
- 57 patients (41.01%) were classified with atypical BPPV (Group B), and 82 with typical BPPV (Group A).
- Group A required significantly fewer treatment sessions and maneuvers (p < 0.001).
- Symptom resolution occurred immediately after maneuvers in 74.07% of Group A cases versus 39.66% during follow-up in Group B (p < 0.001).
Conclusions:
- Atypical BPPV forms are more prevalent in tertiary referral centers than previously assumed.
- Nystagmus patterns can guide the localization of canaliths and inform treatment strategies for atypical BPPV.
- Effective management of atypical BPPV relies on recognizing its distinct clinical profile and tailored therapeutic approaches.
Keywords:
BPPVVHITatypical BPPVcanalith jamcanalolithiasiscupulolithiasisdown-beating nystagmusheavy cupulaminimum stimulus strategyvideo head impulse testMore Related Videos
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