Investigate the differential diagnoses of recurrent benign paroxysmal positional vertigo from vestibular function and...

Benign paroxysmal positional vertigo (BPPV) frequently recurs, posing diagnostic challenges when distinguishing recurrent BPPV (rBPPV) from other positional vertigo disorders.

To investigate vestibular and auditory function in rBPPV versus other recurrent positional vertigo patients, and assess the clinical utility of vestibular function tests in differential diagnosis.

Seventy-four patients with rBPPV or other positional vertigo underwent vestibular evoked myogenic potentials (VEMP), caloric test, video head impulse test (vHIT), and pure tone audiometry(PTA) at Beijing Tongren Hospital.

Among 33 rBPPV patients (15 right posterior canal), 41 non-BPPV cases (30 vestibular migraine, VM) were identified. rBPPV showed lower ocular vestibular evoked myogenic potential(oVEMP) elicitation rates and reduced bilateral cervical vestibular evoked myogenic potential(cVEMP) responses. Caloric and vHIT abnormalities were more prevalent in rBPPV, with lower right posterior canal vestibulo-ocular reflex(VOR) gain on vHIT.

The reduced oVEMP elicitation rate and unilateral cVEMP elicited may be directed to rBPPV. Meanwhile, the abnormality of the caloric test and vHIT test may also be related to rBPPV. Other vertigo disorders, such as VM, may also appear position-induced and be confused with rBPPV. Abnormal otolith and semicircular canal function is a key indicator for differential diagnosis in rBPPV.