Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder, and its prevalence is substantial. While primary BPPV has been well studied, the understanding of secondary BPPV is still limited.
Objective
To investigate the prevalence and clinical characteristics of secondary BPPV in a national multicenter retrospective analysis.
Methods
The study involved a retrospective analysis of medical records from 17 institutions across South Korea, between January and June 2022. We evaluated clinical features, presumed etiologies, involvement of semicircular canals, response to canalith repositioning procedures (CRPs), presence of residual dizziness, recurrence, and results of auditory and vestibular function tests for both primary and secondary BPPV cases.
Results
Of the total 1363 BPPV cases, 14.5% (198 patients) were categorized as secondary BPPV. The most prevalent etiology for secondary BPPV was head trauma. Secondary BPPV was associated with a higher prevalence of comorbidities including diabetes and inner ear diseases. Patients with secondary BPPV demonstrated more frequent involvement of multiple semicircular canals, necessitated a greater number of CRPs for resolution, and experienced a higher incidence of residual dizziness compared to primary BPPV cases. Furthermore, secondary BPPV patients exhibited more frequent abnormalities in auditory and vestibular function tests.
Conclusions
Secondary BPPV accounts for a significant proportion of BPPV cases, with distinct clinical characteristics compared to primary BPPV.
von BrevernMRadtkeALeziusF, et al.Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry2007; 78: 710–715.
3.
ImaiTItoMTakedaN, et al.Natural course of the remission of vertigo in patients with benign paroxysmal positional vertigo. Neurology2005; 64: 920–921.
4.
LimY-HKangKLeeH-W, et al.Gait in benign paroxysmal positional vertigo. Front Neurol2021; 12: 633393.
5.
ChenJZhangSCuiK, et al.Risk factors for benign paroxysmal positional vertigo recurrence: a systematic review and meta-analysis. J Neurol2021; 268: 4117–4127.
6.
JeongS-HKimJ-SShinJW, et al.Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo. J Neurol2013; 260: 832–838.
7.
BalatsourasDGGanelisPAsprisA, et al.Benign paroxysmal positional vertigo associated with Meniere's disease: epidemiological, pathophysiologic, clinical, and therapeutic aspects. Ann Otol Rhinol Laryngol2012; 121: 682–688.
8.
BalatsourasDGKoukoutsisGAsprisA, et al.Benign paroxysmal positional vertigo secondary to mild head trauma. Ann Otol Rhinol Laryngol2017; 126: 54–60.
9.
BalatsourasDGKoukoutsisGGanelisP, et al.Benign paroxysmal positional vertigo secondary to vestibular neuritis. Eur Arch Otorhinolaryngol2014; 271: 919–924.
10.
BalohRWHonrubiaVJacobsonK. Benign positional vertigo: clinical and oculographic features in 240 cases. Neurology1987; 37: 371–378.
11.
BanJHLeeNHChoiHJ, et al.Clinical characteristics of secondary BPPV. Journal of the Korean Balance Society2007; 6: 196–201.
12.
CaldasMAGanançaCFGanançaFF, et al.Clinical features of benign paroxysmal positional vertigo. Braz J Otorhinolaryngol2009; 75: 502–506.
13.
GordonCRLeviteRJoffeV, et al.Is posttraumatic benign paroxysmal positional vertigo different from the idiopathic form?Arch Neurol2004; 61: 1590–1593.
LeeN-HBanJ-HLeeK-C, et al.Benign paroxysmal positional vertigo secondary to inner ear disease. Otolaryngol Head Neck Surg2010; 143: 413–417.
18.
LiPZengX-l.LiY, et al.Clinical analysis of benign paroxysmal positional vertigo secondary to Meniere’s disease. Sci Res Essays2010; 5: 3672–3675.
19.
AronMLeaJNakkuD, et al.Symptom resolution rates of posttraumatic versus nontraumatic benign paroxysmal positional vertigo: a systematic review. Otolaryngol Head Neck Surg2015; 153: 721–730.
20.
ChenCCChoHSLeeHH, et al.Efficacy of repositioning therapy in patients with benign paroxysmal positional vertigo and preexisting central neurologic disorders. Front Neurol2018; 9: 486.
21.
PowerLMurrayKSzmulewiczDJ. Characteristics of assessment and treatment in benign paroxysmal positional vertigo (BPPV). J Vestib Res2020; 30: 55–62.
22.
Lopez-EscamezJACareyJChungWH, et al.Diagnostic criteria for Menière's disease. J Vestib Res2015; 25: 1–7.
23.
JongkeesLMaasJPhilipszoonA. Clinical NystagmographyA detailed study of electro-nystagmography in 341 patients with vertigo. Pract Otorhinolaryngol1962; 24: 65–93.
24.
GanançaCFCaovillaHHGazzolaJM, et al.Epley’s maneuver in benign paroxysmal positional vertigo associated with Meniere’s disease. Braz J Otorhinolaryngol2007; 73: 506–512.
25.
ChenGLiYSiJ, et al.Treatment and recurrence of traumatic versus idiopathic benign paroxysmal positional vertigo: a meta-analysis. Acta Otolaryngol2019; 139: 727–733.
26.
YangCJLeeJWKimSJ, et al.Development of a murine model of traumatic benign paroxysmal positional vertigo: a preliminary study. Acta Otolaryngol2017; 137: 29–34.
27.
HornibrookJ. Saccular otoconia as a cause of Ménière’s disease: hypothesis based on two theories. J Laryngol Otol2018; 132: 771–774.
28.
RigaMBibasAXenellisJ, et al.Inner ear disease and benign paroxysmal positional vertigo: a critical review of incidence, clinical characteristics, and management. Int J Otolaryngol2011; 2011: 709469.
29.
GrossEMRessBDViirreES, et al.Intractable benign paroxysmal positional vertigo in patients with Meniere’s disease. Laryngoscope2000; 110: 655–659.
30.
MandalàMSantoroGPAwreyJ, et al.Vestibular neuritis: recurrence and incidence of secondary benign paroxysmal positional vertigo. Acta Otolaryngol2010; 130: 565–567.
31.
FetterMDichgansJ. Vestibular neuritis spares the inferior division of the vestibular nerve. Brain1996; 119: 755–763.
32.
KimMBBanJH. Benign paroxysmal positional vertigo accompanied by sudden sensorineural hearing loss: a comparative study with idiopathic benign paroxysmal positional vertigo. Laryngoscope2012; 122: 2832–2836.
33.
KimJSLopezIDiPatrePL, et al.Internal auditory artery infarction. Neurology1999; 52: 40.
34.
KimH-JLeeJ-OKimJ-S. Otoconial degeneration after transient ischemia induced by four-vessel occlusion in rats. J Clin Neurol2023; 19: 478–482.
35.
AhnSKJeonSYKimJP, et al.Clinical characteristics and treatment of benign paroxysmal positional vertigo after traumatic brain injury. J Trauma2011; 70: 442–446.
36.
MotinMKerenOGroswasserZ, et al.Benign paroxysmal positional vertigo as the cause of dizziness in patients after severe traumatic brain injury: diagnosis and treatment. Brain Inj2005; 19: 693–697.
37.
PisaniVMazzoneSDi MauroR, et al.A survey of the nature of trauma of post-traumatic benign paroxysmal positional vertigo. Int J Audiol2015; 54: 329–333.
38.
TürkBAkpinarMKayaKS, et al.Benign paroxysmal positional vertigo: comparison of idiopathic BPPV and BPPV secondary to vestibular neuritis. Ear Nose Throat J2021; 100: 532–535.
39.
KeYMaXJingY, et al.Risk factors for residual dizziness in patients with benign paroxysmal positional vertigo after successful repositioning: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol2022; 279: 3237–3256.
40.
PollakLDaviesRALuxonLL. Effectiveness of the particle repositioning maneuver in benign paroxysmal positional vertigo with and without additional vestibular pathology. Otol Neurotol2002; 23: 79–83.
41.
FuWHeFBaiY, et al.Risk factors of residual dizziness after successful treatment for benign paroxysmal positional vertigo in middle-aged and older adults. Front Neurol2022; 13: 850088.
42.
Di CesareTTricaricoLPassaliGC, et al.Traumatic benign paroxysmal positional vertigo: personal experience and comparison with idiopathic BPPV. Int J Audiol2021; 60: 393–397.
