Characteristics and efficacy of canalith-repositioning maneuvers for benign paroxysmal positional vertigo in very...

Benign paroxysmal positional vertigo (BPPV) is highly prevalent in very elderly patients (aged ≥80 years), who present complex comorbidities, atypical manifestations, poor mobility, and high fall risk, leading to diagnostic and therapeutic challenges. Evidence on this population is scarce.

To clarify clinical features, treatment efficacy, recurrence patterns, and risk factors in very elderly BPPV patients.

Retrospective analysis of 128 very elderly patients with BPPV.

Treatment was tolerated by 93.75% (120/128); cure and improvement rates were 93.3% (112/120) and 97.5% (117/120), respectively. The crude recurrence rate was 23.2% (26/112); 76.9% of recurrences were ipsilateral, with 69.2% involving the same canal. Kaplan-Meier estimates, accounting for censored observations, yielded cumulative recurrence rates of 6.3% (95% CI: 1.7%-10.6%) at 1 month, 14.3% (95% CI: 7.6%-20.5%) at 3 months, 18.2% (95% CI: 10.7%-25.1%) at 6 months, and 24.4% (95% CI: 15.3%-32.7%) at 12 months. Multivariable Cox regression identified prior BPPV (HR = 2.416, p = 0.039) and sleep disturbance (HR = 2.448, p = 0.028) as independent predictors.

Very elderly patients (aged ≥80 years) with BPPV show high treatment tolerance and favorable outcomes. Prior BPPV and sleep disturbance are independent predictors of recurrence. Individualized repositioning strategies are recommended.