Traumatic BPPV-A Large Series Analysis of 4839 Patients, Including Comprehensive Vestibular Testing

To provide a comprehensive insight into incidence, characteristics, and associations of post-traumatic head injury BPPV (t-BPPV) with focus on typical posterior canal canalolithiasis.

Retrospective case review.

Tertiary referral center.

A total of 4839 patients assessed from 1998 to 2023 in the Province of Ontario, Canada presenting with significant complaints of dizziness/vertigo following work-related head injury.

All subjects had a detailed neurotological history/examination, vestibular/ audiometric evaluations within a single quaternary neurotological center, which included video nystagmography, video head impulse testing (or a magnetic scleral search coil study), vestibular-evoked myogenic potentials, and pure tone audiometry.

Age, sex, class of injury, injury severity, head trauma direction, requirement for surgery, loss of consciousness, imaging findings, descriptive symptoms, hearing loss, tinnitus, aural pressure, otalgia, otorrhoea, hyperacusis, anosmia/hyposmia, laboratory test results, and findings on Dix-Hallpike positioning were recorded and interrogated for associations.

The rate of t-BPPV was 4.61%. The majority had typical posterior semicircular canal canalolithiasis. Factors that demonstrated positive association with a diagnosis of typical t-BPPV include increased age, male sex, concurrent hearing loss, increased severity of head injury, loss of consciousness, trauma directed from behind, and concurrent olfactory dysfunction. Concurrent aural pressure, tinnitus, otalgia, otorrhea, and hyperacusis did not demonstrate an association with t-BPPV, nor did abnormal caloric, vHIT, or VEMP responses.

T-BPPV is a relatively uncommon finding after TBI but when present is more likely to be caused by posterior canal canalolithiasis. Patients typically experience unilateral posterior canalithiasis but a significant minority present with findings suggestive of other canal involvement or noncrystalline/central pathology. Prognosis for resolution, quality of life, and impact on a worker's functional abilities needs further study.