Slow-Phase Nystagmus Velocity as a Risk Factor for Lateral Canal BPPV Recurrence

Area of Science:

• Otolaryngology
• Neurology
• Vestibular Disorders

Background:

• Benign paroxysmal positional vertigo (BPPV) frequently recurs, affecting up to 50% of patients within 10 years.
• While systemic risk factors for BPPV are documented, objective otologic predictors of recurrence remain largely unexamined.

Purpose of the Study:

• To investigate the slow-phase velocity (SPV) of positional nystagmus as a predictor of recurrence in lateral semicircular canal BPPV.
• To identify objective otologic parameters that can stratify BPPV recurrence risk.

Main Methods:

• A retrospective cohort study included 259 patients diagnosed with lateral semicircular canal BPPV between 2020 and 2024.
• Initial SPV was measured using videonystagmography. Recurrence was defined as symptom re-presentation requiring repeat therapy at least one month post-resolution.
• Binomial logistic regression analysis was employed to identify independent risk factors for BPPV recurrence.

Main Results:

• Patients who experienced recurrence exhibited significantly higher initial SPV and lower serum calcium levels compared to non-recurrence cases.
• Initial SPV and serum calcium were identified as independent predictors of BPPV recurrence.
• No correlation was found between initial SPV and recurrence SPV or timing, suggesting independent otolithic events contribute to recurrence.

Conclusions:

• Initial SPV measured at diagnosis is a novel, independent risk factor for the recurrence of lateral semicircular canal BPPV.
• This routinely obtainable parameter may reflect an underlying otolithic burden, enabling better risk stratification.
• Findings support tailored follow-up strategies and preventive interventions for patients at higher risk of BPPV recurrence.