Natural history of horizontal canal benign paroxysmal positional vertigo is truly short

Abstract

The objective of the study is to characterize the natural course of positional vertigo and nystagmus in patients with horizontal canal benign paroxysmal positional vertigo (h-BPPV) and to analyze the difference in the natural course between the two variants of h-BPPV. We conducted a prospective study in 106 patients with geotropic type h-BPPV [h-BPPV (Geo)] (n = 43) and apogeotropic type h-BPPV [h-BPPV (Apo)] (n = 63) who agreed and signed the written informed consent of no treatment. All patients were asked to answer a detailed interview about the onset time of positional vertigo and to visit the hospital every 1-3 days. At every visit, they were interviewed about cessation time of positional vertigo and positional nystagmus was assessed. The mean period ± SD between the onset and remission of vertigo in the h-BPPV (Geo) was 6.7 ± 6.3 days, whereas that in the h-BPPV (Apo) was 3.7 ± 4.1 days. In addition, the mean period ± SD from the initial diagnosis to the disappearance of positional nystagmus in the h-BPPV (Geo) was 4.7 ± 3.9 days, whereas that in the h-BPPV (Apo) was 4.4 ± 5.0 days. Although the duration until natural remission of positional nystagmus did not differ between the two variants of h-BPPV, the remission of vertigo occurred faster in h-BPPV (Apo) than h-BPPV (Geo) (p < 0.05). The natural course of h-BPPV is much shorter than that indicated in previous reports. The positional vertigo disappeared faster in the h-BPPV (Apo) compared to the h-BPPV (Geo) unlike the positional nystagmus.

Efficacy of Computer-Controlled and Modified Roll Maneuver for Treatment of Geotropic Lateral Canal Benign Paroxysmal Positional Vertigo

“…Second, the natural resolution of BPPV is more common in LC-BPPV especially the geotropic variant (2,6,25). A study showed that the course from the onset to remission of vertigo in 36 patients with untreated geotropic LC-BPPV was 16 T 19 days, and 53% of them had spontaneous disappearance of vertigo within 7 days (6), and a recent study indicated that the course was shorter (6.7 T 6.3 d) in the patients with untreated geotropic LC-BPPV (25).…”

“…A study showed that the course from the onset to remission of vertigo in 36 patients with untreated geotropic LC-BPPV was 16 T 19 days, and 53% of them had spontaneous disappearance of vertigo within 7 days (6), and a recent study indicated that the course was shorter (6.7 T 6.3 d) in the patients with untreated geotropic LC-BPPV (25). But a previous study demonstrated that only 17% of 18 patients with untreated LC-BPPV showed spontaneous resolution of vertigo after 1 week, and 28% of the patients had persistent vertigo for several months (20).…”

Treatment of horizontal canal BPPV—a randomized sham‐controlled trial comparing two therapeutic maneuvers of different speeds

“…BPPV is often a self-limiting condition, 12,13 but can be persistent or recurrent. [14][15][16][17] BPPV may cause considerable handicap for patients, restricting work as well as other activities of daily living.…”

Refractory Positional Vertigo With Apogeotropic Horizontal Nystagmus After Labyrinthitis

“…In general, this subtype of BPPV has a favorable prognosis. A prospective study evaluating its natural history found that spontaneous resolution occurred by 6.7 and 3.7 days for the geotropic and apogeotropic variants, respectively (8).…”