Predictors of residual dizziness in patients with benign paroxysmal positional vertigo after successful repositioning: A multi-center prospective cohort study

Abstract

BACKGROUND: While patients with benign paroxysmal positional vertigo (BPPV) commonly develop residual dizziness (RD) after successful repositioning, the factors predictive of RD remain controversial. OBJECTIVE: To identify factors predictive of RD onset in patients with BPPV following successful repositioning. METHODS: This multi-center prospective cohort study enrolled 243 patients with idiopathic BPPV. Vestibular functional and psychological wellbeing assessments administered before repositioning provided the data used to identify factors predictive of RD with a log-binomial model. The endpoint was RD at 1 week after successful repositioning. RESULTS: Of the enrolled patients, 118 reported RD. After adjusting for cofounders, mild [risk ratio (RR), 2.06; 95% confidence interval (CI), 1.39–3.04] or severe (RR, 3.08; 95% CI, 2.17–4.38) anxiety and abnormal vestibular ratio of sensory organization test (RR, 2.68; 95% CI, 1.82–3.95) were identified as risk predictors. Presence of ocular vestibular evoked myogenic potentials responses, either unilateral (RR, 0.55 95% CI, 0.44–0.69) or bilateral (RR, 0.49, 95% CI, 0.36–0.68), were protective factors. CONCLUSIONS: Anxiety and abnormal balance are significant predictors of RD, while the presence of ocular vestibular evoked myogenic potentials responses predicts against it. These findings may help to improve BPPV outcomes by informing prognoses and guiding treatment strategies. Trial registration: ChiCTR1800018004 (date of registration: 26 August 2018)

Recovery of Regular Daily Physical Activities Prevents Residual Dizziness after Canalith Repositioning Procedures

“…RD is considered a complex vestibular disorder and several hypotheses have been proposed to explain its pathophysiology [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. Although theoretically valid, none of them has been supported by definitive data, nor do they exclude other causal factors that could play a role in the genesis of RD acting either independently or synergistically.…”

“…Therefore, central adaptation cannot promptly restore the pre-existing condition and produces subtle symptoms consistent with RD. The delayed central adaptation is associated with many factors, such as BPPV duration [ 10 , 11 ], age [ 10 , 11 , 12 , 13 , 14 , 15 , 16 ], and the subject’s emotional state [ 12 , 13 , 14 ]. Furthermore, it should be considered that aging significantly degrades sensory systems, worsening central processes measuring balance and body perception, therefore predisposing to dizziness and disequilibrium [ 30 ].…”

“…Furthermore, it should be considered that aging significantly degrades sensory systems, worsening central processes measuring balance and body perception, therefore predisposing to dizziness and disequilibrium [ 30 ]. It is well known how advancing age could increase the incidence of RD, representing an important variable to be considered [ 13 , 15 ]. These data are in accordance with the results of this study and with data already collected in our previous investigation [ 12 ], in which we described how age influenced the occurrence of imbalance after successful CRP.…”

“…Several hypotheses have been proposed to explain the pathomechanism underlying residual symptoms after successful repositioning procedures. Possible explanations include either the persistence within the canal lumen of a too limited number of residual debris to provoke detectable positional nystagmus, the persistence of utricular dysfunction accompanying BPPV, and the occurrence of long-lasting central adaptation mechanisms [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. In previous research, the overall prevalence of RD ranges between 36.6% and 61% [ 10 ], and both vestibular rehabilitation and various drugs have been proposed to manage this condition [ 22 , 23 , 24 ].…”

Clinical and cVEMP Evaluation Predict Short-Term Residual Dizziness After Successful Repositioning in Benign Paroxysmal Positional Vertigo

“…It is reported that decreased VEMPs response, especially oVEMP abnormality, plays an important role in BPPV occurrence and recurrence. Whereas, only a few studies are focused on VEMP evaluation and RD ( 9 , 11 , 12 , 28 ). The lack of stratified design and limited sample size may explain the inconsistency around whether a decreased or an augmented cVEMP response is truly related to RD as noted in the previous literature.…”