Residual dizziness after the first BPPV episode: role of otolithic function and of a delayed diagnosis

Abstract

Residual dizziness (RD) following the resolution of a benign paroxysmal positional vertigo (BBPV) episode is frequently reported by patients. Possible causes are still under debate in the literature. This study discusses the possible role of otolithic function and of elapsed time from onset of symptoms to diagnosis in the genesis of RD. In total, 116 patients younger than 65 years with their first episode of BPPV and without any other comorbidities were enrolled in the study. Before a bedside examination, subjective visual vertical (SVV) was determined in the case of a history suggestive of BPPV. SVV was tested 1 week later in those patients with BPPV of the posterior semicircular canal, and in whom positioning maneuvers showed resolution of BPPV. At 1 week control, reported RD and Dizziness Handicap Inventory (DHI) were recorded. Diagnosis and treatment of BPPV occurred within 4 days in 43 patients (group A), between 5 and 8 days in 38 patients (group B) and in more than 9 days in 35 patients (group C). Higher values of reported RD and DHI were recorded in group C, while higher values of SVV deviation were recorded in group A with an inverse relationship between SVV and DHI. Initial peripheral vestibular function asymmetry due to BPPV can induce a new central adaptation. This adaptation becomes better established the longer otoconia remain floating in the endolymph. Because of these changes, the brain is unable to quickly readapt to the old pattern after resolution resulting in more persistent RD.

Efficacy of Repositioning Therapy in Patients With Benign Paroxysmal Positional Vertigo and Preexisting Central Neurologic Disorders

“…A larger case-control study in the future is needed to verify this finding. The findings of more frequent RD in patients with short (≤4 days) symptom durations in our study were different from previous studies (11, 18, 27–29). We assumed that symptom durations may not be the sole factor in the development of RD.…”

“…Risk factors, including aging, a long symptom duration, and anxiety were previously proposed, but study results are conflicting (10, 18, 27–31). Optimal management of RD remains unclear.…”

“…A significant difference was defined as p < 0.05. Inspired by Faralli et al (18), the correlation of RD and symptom duration in the entire cohort was analyzed as well. Short, medium, and long symptom durations were respectively defined as intervals between onset and treatment of ≤4, 5–8, and ≥9 days.…”

Residual Dizziness after Successful Repositioning Maneuver for Idiopathic Benign Paroxysmal Positional Vertigo: A Review

“…17-20 Moreover, at the diagnosis, RD seems not to be related with involved canal, gender, number of repositioning maneuvers or severity of nystagmus, 17-20 and the main causal factor seems to be linked to the duration of vertigo before successful repositioning maneuvers. 17,20,21 There is no agreement about the correlation between RD and duration of BPPV 18 as well on the incidence of RD in migraineurs 20 generally the mean age of patients affected by BPPV and migraine is lower than a control group of not migraineurs. 22,23 RD after BPPV episode is a common condition among the elderly.…”

“…These alterations appeared to be rapidly reversible and in these cases the otolith dysfunction could explain only brief dizziness after CRP, but not delayed RD after one week. 21 In 2006 Von Brevern et al demonstrated that a documented otolith dysfunction in patients affected by idiopathic BPPV might account for transient mild imbalance experienced after the resolution of the acute vertigo. In their study the otolith function of patients was tested 1 week and 1 month after successful treatment and compared with 24 healthy subjects.…”