Meta-analysis of the therapeutic effects of traumatic BPPV and idiopathic BPPV

To systematically evaluate differences in treatment efficacy and prognosis between traumatic benign paroxysmal positional vertigo (t-BPPV) and idiopathic BPPV (i-BPPV), and to provide evidence-based guidance for clinical practice.

We systematically searched 8 databases (PubMed, EMBASE, Cochrane Library, Web of Science, CBMdisc, Wanfang, CNKI, and VIP) for cohort studies comparing t-BPPV and i-BPPV, with the search period extending until September 2023. Two independent reviewers screened literature, extracted data, and assessed methodological quality using the Newcastle-Ottawa Scale (NOS). Meta-analyses were performed using RevMan 5.3 and Stata 12.0. Risk ratios (RR) with 95% confidence intervals (CI) were calculated for dichotomous outcomes. Heterogeneity was evaluated via p-values and I²statistics, with fixed-effects models applied for I² ≤ 50% and random-effects models otherwise.

Seven high-quality cohort studies (NOS ≥ 6) involving 4,074 patients were included. Compared with i-BPPV, t-BPPV demonstrated significantly poorer outcomes across all metrics: higher recurrence rate (RR = 3.39, 95%CI 3.07-3.74, p < 0.00001), greater repositioning difficulty (RR = 3.05, 95%CI 2.74-3.40, p < 0.00001), lower treatment efficacy (RR = 0.87, 95%CI 0.84-0.90, p < 0.00001), higher proportion of multi-semicircular canal involvement (RR = 2.91, 95%CI 1.55-5.47, p = 0.0009), and elevated bilateral BPPV incidence (RR = 3.37, 95%CI 1.86-6.10, p < 0.00001). Egger's test revealed no significant publication bias for any outcome (p > 0.05).

t-BPPV exhibits inferior repositioning efficacy, higher risks of residual symptoms and recurrence, and increased rates of multi-semicircular canal and bilateral involvement compared with i-BPPV. Clinicians should adopt tailored management strategies for t-BPPV, emphasizing long-term follow-up and personalized interventions.