Risk Factors for the Recurrence of Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-Analysis

Advancing personalized healthcare: leveraging explainable AI for BPPV risk assessment

Background

Benign Paroxysmal Positional Vertigo (BPPV) is a common vestibular disorder significantly impacting older adults, characterized by brief episodes of vertigo triggered by head movements. Accurate and timely diagnosis of BPPV can be challenging due to its overlapping symptoms with other conditions. Machine learning (ML) offers a promising approach to enhance diagnostic accuracy and efficiency.

Purpose

The primary purpose of this study was to evaluate the efficacy of various ML models in predicting BPPV. This common vestibular disorder significantly impacts older adults. This research sought to build models that could accurately predict BPPV using readily available clinical data and to assess the application of Explainable Artificial Intelligence (XAI) to enhance transparency and trust in ML-driven diagnoses.

Methods

In this study, we trained and evaluated several ML models on a rich dataset from Froedtert Hospital involving 7,760 patients characterized by a diverse range of demographic and clinical features. This robust dataset enabled a detailed exploration of the factors influencing BPPV. By employing explainable AI techniques, we aimed to enhance the predictive accuracy of our models and provide clinicians with transparent and interpretable insights into diagnostic reasoning, bridging the gap between machine learning efficacy and clinical usability.

Results

Gradient Boosting emerged as the most effective model, exhibiting the highest accuracy (85.422%), F1 (0.851), and AUC (0.911). Statistical analysis revealed significant demographic disparities in BPPV occurrence. Specifically, the odds ratio (OR) for BPPV among "White or Caucasian" individuals was 2.433 (p < 0.001), indicating a higher prevalence compared to other races. Conversely, "Black or African American" individuals had an OR of 0.851 (p < 0.05), and "Asian" individuals had an OR of 0.791 (p = 0.26). The study also found an OR of 4.498 (p < 0.001) for "Not Hispanic or Latino" individuals, suggesting a significantly higher prevalence of BPPV in this group. The application of XAI facilitated a deeper understanding and trust in model decisions, particularly highlighting how model predictions align with clinical indicators.

Conclusion

The study confirms that machine learning, complemented by Explainable AI, can effectively predict BPPV with high accuracy and interpretability. Leveraging XAI enhances the usability and acceptance of ML predictions in clinical settings, enabling healthcare providers to integrate these insights into their diagnostic processes. Future work should focus on further integrating these models into clinical practice to facilitate early and accurate BPPV diagnosis.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13755-024-00317-3.

Risk factors and nomogram model for recurrence of benign paroxysmal positional vertigo in postmenopausal women: a multicenter cross-sectional study

Objective

To explore the risk factors for recurrent benign paroxysmal positional vertigo (BPPV) in postmenopausal women within 1 year of canalith repositioning procedure (CRP), and develops a risk model based on serum 25-hydroxyvitamin D (25(OH)D), estradiol, and calcium levels to provide early identification of high-risk groups and guide prevention and treatment strategies.

Methods

Data from postmenopausal women with BPPV, diagnosed and successfully treated with CRP at five hospitals in Sichuan Province between January 2019 and January 2024, were retrospectively analyzed. Participants were divided into BPPV validation and training sets in a 3:7 ratio. Clinical data were categorized into recurrence and non-recurrence subgroups based on whether BPPV recurred after treatment. LASSO regression identified factors influencing recurrence within 1 year after CRP, and multivariate logistic regression (MLR) analysis was used to develop a risk nomogram prediction model (NPM).

Results

A total of 490 patients were enrolled, with 147 in the validation set and 343 in the training sets. Among them, 151 patients (30.82%) experienced recurrenced, including 58 (30.61%) in the validation set and 106 (30.90%) in the training sets. LASSO and MLR analyses identified migraine (OR = 2.208, 95% CI = 1.278-3.817), serum calcium (OR = 0.601, 95% CI = 0.447-0.81), 25(OH)D (OR = 0.785, 95% CI = 0.713-0.864), and serum estradiol (OR = 0.820, 95% CI = 0.752-0.894) as significant factors influencing recurrence within 1 year after CRP treatment in postmenopausal women with BPPV.

Conclusion

The recurrence rate of BPPV within 1 year after CRP treatment in postmenopausal women is high. Migraine, 25(OH)D, calcium, and estradiol are associated with recurrence. The risk prediction model, developed using these factors, demonstrates good discrimination and calibration. It effectively predicts the recurrence risk within 1 year after successful CRP treatment, offering practical clinical value.

Atypical symptoms and delayed diagnosis are more common in elderly patients with benign paroxysmal positional vertigo: a single-center study

Objective

To analyze the clinical characteristics of elderly patients with benign paroxysmal positional vertigo (BPPV), to provide a basis for the accurate diagnosis of elderly BPPV patients.

Methods

A retrospective case-control study was conducted to evaluate the clinical data of 12,282 patients diagnosed with BPPV who received treatment at the Vertigo Clinical Diagnosis and Treatment Research Center of Beijing Tiantan Hospital, affiliated with Capital Medical University, between January 2020 and June 2024. Patients were categorized into an elderly group (≥65 years old) and a young-to-middle-aged group (<65 years old). Risk factors, clinical manifestations, and the interval from symptom onset to diagnosis were systematically compared and analyzed.

Results

The mean age of elderly BPPV patients was 71.2 ± 5.4 years, with a male-to-female ratio of approximately 1:2. The posterior semicircular canal was the most commonly affected site (62.3%) in elderly patients, and the incidence of horizontal semicircular canal canalolithiasis was higher in the elderly group compared to the young-to-middle-aged group (16.2% vs. 13.6%, p < 0.001). The prevalence of arteriosclerosis-related risk factors (including hypertension, diabetes, hyperlipidemia, and coronary heart disease) was significantly higher (p < 0.001). Elderly patients with BPPV were more likely to experience atypical symptom (40.5% vs. 35.5%, p < 0.001), isolated vestibular symptom episodes lasting more than 1 min (23.1% vs. 21.4%, p = 0.039), and symptoms accompanied by tinnitus (21.0% vs. 18.8%, p = 0.004) and hearing loss (12.7% vs. 8.6%, p < 0.001). The proportion of elderly patients whose vertigo was triggered by typical head or body position changes was significantly lower than that in the younger group (35.3% vs. 39.7%, p < 0.001). Additionally, the time from symptom onset to diagnosis was positively correlated with age (r = 0.122, p < 0.001), and a significantly higher proportion of elderly patients experienced a diagnostic delay exceeding 14 days (35.4% vs. 28.4%, p < 0.001).

Conclusion

Elderly patients with BPPV are more likely to present with atypical symptoms, fewer episodes of position-induced vertigo, and a longer symptom duration. Delayed diagnosis is more prevalent among elderly patients.

Co-Existing Vestibular Hypofunction Impairs Postural Control, but Not Frailty and Well-Being, in Older Adults with Benign Paroxysmal Positional Vertigo

Background: Vestibular hypofunction occurs in 29.5% of older adults with benign paroxysmal positional vertigo (BPPV), but its impact on postural control, well-being and frailty was not studied before. This study compared the well-being, frailty and postural control between older adults with BPPV and vestibular hypofunction (oaBPPV+), and older adults with only BPPV (oaBPPV). Methods: Thirty-one older adults (≥65 years old) diagnosed with BPPV were recruited. Unilateral vestibular hypofunction was defined as a >25% caloric asymmetry, and bilateral vestibular hypofunction as a total response <6°/s per ear, using bithermal caloric irrigations. The oaBPPV+ group was compared to the oaBPPV group using the measures of well-being (Dizziness Handicap Inventory, Falls Efficacy Scale and 15-item Geriatric Depression Scale), frailty (Modified Fried Criteria), and postural control (timed chair stand test, mini-Balance Evaluation Systems test and Clinical Test of Sensory Interaction on Balance (CTSIB)). Falls and the number of repositioning maneuvers were documented. Significance level was set at α = 0.05. Results: Unilateral vestibular hypofunction was present in 32% of participants, mainly in females (p = 0.04). Bilateral vestibular hypofunction was not found. The oaBPPV+ group (n = 10, mean age 72.5 (4.5)) experienced more comorbidities (p = 0.02) than the oaBPPV group (n = 21, mean age 72.6 (4.9)). Groups did not differ regarding dizziness symptoms (p = 0.46), fear of falling (p = 0.44), depression (p = 0.48), falls (p = 0.08) or frailty (p = 0.36). However, the oaBPPV+ group showed significantly worse postural control under vestibular-dependent conditions (p < 0.001). Conclusions: Despite equally impaired well-being and frailty, the oaBPPV+ group showed greater sensory orientation deficits. Clinicians and researchers should be alert for co-existing vestibular hypofunction in older adults with BPPV, since this may exacerbate their already impaired postural control more than only BPPV.

Identifying key risk factors for the recurrence of benign paroxysmal positional vertigo following successful canalith repositioning maneuvers: a meta analysis

BACKGROUND

An increasing occurrence trend of benign paroxysmal positional vertigo (BPPV) after successful canalith repositioning maneuvers was observed; however, the risk elements for the occurrence of this disease remain undefined. We aimed to conduct a meta-analysis of BPPV occurrence-associated risk factors reported.

METHODS

A comprehensive search in MEDLINE, EMBASE, PubMed, Springer, and the Cochrane Library up to March 31, 2024. The meta-analysis was carried out with STATA 16.0. Quality evaluation of the articles was performed with the Newcastle-Ottawa Scales (NOS). Data were pooled by a random-effects model. The meta-analysis was registered at INPLASY (202430045).

RESULTS

Seventeen studies with 229 patients were included in the present analysis. The recurrence rate of BPPV after Canalith repositioning procedure (CRP) or Epley maneuver in subjects with hypertension [standardized mean difference (SMD) = 0.88,95% confidence interval (CI) (0.81-0.96), P = 0.00], Meniere's disease [SMD = 0.84, 95%CI (0.57-1.10), P = 0.00], head trauma [SMD = 0.48, 95%CI (0.34-0.63), P = 0.00], diabetes mellitus (DM) [SMD = 0.87, 95%CI (0.80-0.94), P = 0.00], advanced age [SMD = 0.18, 95%CI (0.08-0.28), P = 0.00], osteoporosis [SMD = 0.32, 95%CI (0.20-0.43), P = 0.00], female gender [SMD = 0.53, 95%CI (0.40-0.67), P = 0.00], migraine headache [SMD = 0.20, 95%CI (0.06-0.35), P = 0.01], and vitamin D deficiency [OR = 0.29, 95%CI (0.18-0.40), P = 0.00] were appreciably higher than those in patients without hypertension, Meniere's disease, head trauma, DM, advanced age, osteoporosis, female gender, migraine headache, and vitamin D deficiency.

CONCLUSION

This meta-analysis has identified several significant risk factors associated with the recurrence of BPPV following successful canalith repositioning procedures. These include Meniere's disease, head trauma, diabetes mellitus, migraine headaches, female gender, advanced age, osteoporosis, and vitamin D deficiency.

Risk factors and a nomogram model for recurrence of benign paroxysmal positional vertigo: a multicenter cross-sectional study

Objective

To explore factors influencing the recurrence of benign paroxysmal positional vertigo (BPPV) within 1 year after treatment with canalith repositioning procedure (CRP) and to construct a risk prediction model with a nomogram. This model aims to offer a scientific basis for of high-risk groups' early identification and to support the development of prevention strategies.

Methods

Data of BPPV patients diagnosed and successfully treated with CRP of 5 hospitals in Sichuan Province from Jan 2020 to Mar 2024 were retrospectively analyzed. The patients were divided into a training set of BPPV and a set of validation with a 7:3 ratio. After organizing the clinical data, the training set's patients were arranged into recurrent and non-recurrent subgroups based on the recurrence of BPPV within one-year post-treatment. Factors affecting BPPV recurrence were found using LASSO regression; then, multivariate logistic regression (MLR) analysis was used to build a nomogram-style risk prediction model. The "receiver operating characteristic" (ROC) curve, Hosmer-Lemeshow calibration curve, clinical "decision curve analysis" (DCA), and clinical impact curve were employed to assess the model's discrimination, accuracy, and clinical applicability.

Results

600 patients in all were involved; 180 were in the validation set and 420 in the training set, following a 7:3 split. The overall recurrence rate of BPPV within 1 year was 39.17% (235/600 cases). The recurrence rates in the validation and training sets were 39.44% (71/180 cases) and 39.05% (164/420 cases), respectively. LASSO regression and logistic regression analyses identified hypertension, hyperglycemia, migraine, HADS-A, and 25(OH)D as significant factors for recurrence. On the basis of these factors, a nomogram prediction model for recurrence was established. The validation and training sets had an area under the ROC curve of 0.723 (95%CI: 0.645-0.801) and 0.728 (95%CI: 0.679-0.777), respectively. The "Hosmer-Lemeshow goodness-of-fit (HLGOF) test" indicated satisfactory calibration (training set: chi-square = 8.708, p = 0.368; validation set: chi-square = 13.303, p = 0.102). The analysis exhibited an excellent consistency between the model's predicted probabilities and actual outcomes. DCA and clinical impact curve analyses indicated a positive net clinical benefit at various threshold probability levels, affirming the clinical value of the nomogram model in forecasting BPPV recurrence.

Conclusion

BPPV patients treated with CRP exhibit a high recurrence rate within one-year post-treatment. Hypertension, hyperglycemia, migraine, HADS-A, and 25(OH)D levels were related with increased recurrence risk. The risk prediction model, presented as a nomogram, demonstrated good discrimination and calibration, effectively predicting the BPPV's recurrence risk within 1 year and offering significant clinical utility.

Influencing Factors for Residual Symptoms Following Canalith Repositioning Maneuver in Patients with Benign Paroxysmal Positional Vertigo

Objectives: We aimed to analyze the influencing factors for residual symptoms following canalith repositioning maneuvers in patients with benign paroxysmal positional vertigo (BPPV). Methods: A total of 193 patients with BPPV who attended our hospital from July 2019 to December 2023 and were followed up in the outpatient clinic for 4 weeks after treatment were selected. The presence or absence of residual symptoms 4 weeks after repositioning was recorded, based on which the patients were assigned into a presence group (n = 72) and an absence group (n = 121). Their general data, incidence features, mental health, and sleep quality were compared. Results: After canalith repositioning maneuver and 4-week follow-up, the Dizziness Handicap Inventory (DHI) scores, Hospital Anxiety and Depression Scale (HADS) scores, and Pittsburgh Sleep Quality Index (PSQI) scores of the BPPV patients significantly decreased (P < .05). The presence of residual symptoms after repositioning in patients with BPPV had significant positive correlations with the time from onset to consultation, DHI score, HADS anxiety score, and PSQI score (P < .05). The area under the curve of the DHI score for predicting residual symptoms after repositioning in patients with BPPV was the largest (0.727), and the time from onset to consultation and the HADS anxiety score had the highest sensitivity (0.764) and specificity (0.801), respectively. Conclusions: Time from onset to consultation, DHI score, HADS anxiety score, and PSQI score are independent risk factors for and display significantly positive correlations with residual symptoms after canalith repositioning maneuver in patients with BPPV.

New- and early-onset benign paroxysmal positional vertigo after otologic surgery

PURPOSE

To determine the frequency and clinical features of new- and early-onset benign paroxysmal positional vertigo (BPPV) after different otologic surgical operations with and without surgical drilling.

METHODS

All unilateral otologic operations performed at the otolaryngology clinic of a tertiary university hospital between January 2021 and May 2023 were screened, and 437 adult cases were included in the study. Of these patients, those who were diagnosed with BPPV within the first month postoperatively were examined.

RESULTS

The overall incidence of BPPV after otologic operations was 2.28% (10 out of 437 patients). This incidence was 3% (8/266 patients) in cases where a drill was used and 1.16% (2/171 patients) in those where a drill was not used. There was no significant difference between the two groups (p > 0.05). Clinical symptoms related to BPPV appeared on average in 13.3 ± 6.8 (range: 3-25) days following surgery and presented as canalolithiasis. All cases involved the posterior semicircular canal (SCC) on the operated side. In addition, one patient with a cochlear implant had involvement of both the posterior and lateral SCCs. All patients responded well to repositioning maneuvers during follow-up.

CONCLUSION

Otologic surgery, especially operations involving drilling, is a potential risk factor for the development of BPPV. Postoperative BPPV, primarily presenting as canalolithiasis in the posterior SCC on the operated side, can be effectively managed with repositioning maneuvers. Clinicians should be vigilant for BPPV in patients experiencing vertigo/dizziness within four weeks following otologic surgery.

Randomized Controlled Trial Assessing Vitamin D's Role in Reducing BPPV Recurrence in Older Adults

OBJECTIVE

To determine if the recurrence rates of BPPV in older adults were lower in the vitamin D-treated group as compared to placebo groups.

STUDY DESIGN

Double-blinded randomized control placebo trial.

SETTING

A single-centre study.

METHODS

Double-blinded randomized controlled trial design with 12 months follow-up. Vitamin D3 deplete participants were randomized into treatment (Group A) or placebo groups (Group B). Treatment group received 13 weeks of 2000 IU vitamin D3 followed by 1000 IU for the next 13 weeks. Patients who were replete were allocated to a control group (Group C) for observation and follow up. All groups had dietary interventions for vitamin D3 and calcium.

RESULTS

Results showed an 87% reduction in recurrence rates of BPPV in the treatment group (Group A), with 0.75 fewer clinical episodes per 1 person-year as compared to placebo (Group B). Time to first recurrence was also significantly longer in Group A. There was no statistically significant difference between Group A and C in both recurrence rates and dizziness handicap scores.

CONCLUSIONS

This clinical trial has laid the foundation to expand the investigation of vitamin D as standard of care treatment in BPPV patients in future phase IIb and III studies.

SUMMARY

A reduction in BPPV episodes in older adults has implications on fall risk, as dizziness from BPPV may cause falls. With fewer BPPV episodes and longer time to recurrence, seniors may have better postural stability and hence reduced risk of falls.

LEVEL OF EVIDENCE: 2

Benign paroxysmal positional vertigo without dizziness is common in people presenting to falls clinics

PURPOSE

To determine the prevalence of benign paroxysmal positional vertigo without dizziness, a treatable falls risk factor in people attending outpatient falls clinics.

METHODS

Over 6 years, 618 people at risk of falls attending 2 falls clinics were assessed for benign paroxysmal positional vertigo, whether dizzy or non dizzy. Data regarding demographics, canal location of positive tests and comorbidities were collected from medical records.

RESULTS

Thirty-nine percent (238) of people with falls risk tested positive for benign paroxysmal positional vertigo; 62 (26%) or 1 in 4 of those testing positive were not dizzy. Thirty-nine of 104 (38%) testing positive for single canal benign paroxysmal positional vertigo and twenty-four of 134 (18%) testing positive for multiple canal benign paroxysmal positional vertigo were not dizzy. Comorbidities were common for all with falls risk but did not differentiate for benign paroxysmal positional vertigo on testing.

CONCLUSIONS

Benign paroxysmal positional vertigo is common in people attending falls clinics and contributes to falls risk. Dizziness is common in BPPV though 26% or 1 in 4 people testing positive were not dizzy and would be missed without mandatory testing. Testing should also include all semicircular canals as multiple-canal involvement was high.

Exploring the Association of Serum Uric Acid Levels with Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-Analysis

Objectives: The role of uric acid in pathogenesis of benign paroxysmal positional vertigo (BPPV) is not fully understood. It is aimed to assess the serum uric acid levels in BPPV patients compared to healthy controls. Study design: Systematic review and meta-analysis. Methods: Web of science, PubMed, Scopus, Google Scholar, Embase, Medline, and Cochrane library were systematically searched. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Problem/Population, Intervention, Comparison, and Outcome (PICO) guidelines were used. Results: In total, 20 studies including 3967 participants met the inclusion criteria. Ten studies (50%) reported higher uric acid (UA) levels in BPPV patients, 4 studies (20%) indicated lower UA levels in BPPV patients, while 6 studies (30%) found no significant difference in UA levels between BPPV patients and healthy controls. The overall mean serum levels of UA (SMD: 0.265, [-0.163 to 0.693]) were higher in BPPV patients than control group. However, this difference was not statistically significant (P-value: .225). Conclusion: There is no significant difference in serum level of UA between BPPV patients and healthy controls. It means that serum level of UA (whether low or high) is not likely the underlying factor of development of BPPV.

The relationship between dizziness and sleep: a review of the literature

Background

The relation between vestibular disorders and (quality of) sleep is underexplored scientifically and the complex interactions between vestibular and sleep disorders are far from being well understood. Some studies have been conducted on the association between patients with vestibular disorders and (the occurrence of) sleep disorders, other studies have been published on the prevalence of dizziness complaints in patients with sleep disorders. The quality of sleep in patients with vestibular disorders generally receives little attention in clinical practice.

Objective

To establish what is currently known about the mutual relationship between dizziness and sleep, and to assess whether or not there is evidence of causality with regard to this relationship.

Methods

After systematically searching four literature database up until 1 April 2024, selected studies were summarized and evaluated through a (critical) review.

Results

Ultimately, 42 studies were selected and evaluated. Patients with dizziness in general and patients with a specific vestibular disorder like Benign Paroxysmal Positional Vertigo, Vestibular Migraine, Meniere's disease, and vestibular hypofunction were significantly more likely to have sleep disorders than control groups. A causal relationship is not supported due to the nature of the studies. In patients with obstructive sleep apnea syndrome there were significantly more vestibular complaints, and more disorders in the vestibular system were identified.

Conclusion

Dizziness complaints often co-exist with a sleep disorder. To what extent this sleep disorder influences dizziness is not clear. Paying attention to the quality of sleep in patients with a vestibular disorder seems to be important. In patients with OSAS, consideration should be given to vestibular complaints and dysfunction.

Association of Peripheral Vestibular Disorder with Diabetes: A Population-Based Study

BACKGROUND

This study aimed to investigate the association of peripheral vestibular disorders with type 1 and type 2 diabetes using a population-based dataset.

METHODS

The data for this study were obtained from Taiwan's Longitudinal Health Insurance Database 2010. The sample consisted of 150,916 patients who were newly diagnosed with peripheral vestibular disorders as cases and 452,748 propensity-score-matching controls without peripheral vestibular disorders. We utilized multivariate logistic regression models to quantitatively evaluate the association between peripheral vestibular disorders and diabetes while considering factors such as sex, age, geographic location, monthly income, urbanization level of the patient's residence, coronary heart disease, hypertension, and hyperlipidemia.

RESULTS

The chi-squared test indicates that diabetes was more common in the peripheral vestibular disorder group compared to controls (20.6% vs. 15.1%, p < 0.001). Of all sampled patients, the adjusted odds ratio for diabetes was 1.597 (95% CI = 1.570~1.623) for those with peripheral vestibular disorders when compared to controls, while patients with Ménière's disease, benign paroxysmal positional vertigo, unilateral vestibulopathy, and other peripheral vestibular disorders had respective adjusted odds ratios of diabetes at 1.566 (95% CI = 1.498~1.638), 1.677 (95% CI = 1.603~1.755), 1.592 (95% CI = 1.504~1.685), and 1.588 (95% CI = l.555~1.621) in comparison to controls.

CONCLUSIONS

Our research has revealed an association between diabetes and an increased susceptibility to peripheral vestibular disorders.

Risk factors for benign paroxysmal positional vertigo and construction of a nomogram predictive model

BACKGROUND

To analyze the risk factors for benign paroxysmal positional vertigo (BPPV) and to construct a predictive nomogram model.

METHODS

In this retrospective study, 312 participants were enrolled, including 164 BPPV patients and 148 healthy subjects without BPPV. Risk predictors for BPPV were identified using univariate and multivariate analyses, and a clinical nomogram was constructed. The predictive accuracy was assessed by unadjusted concordance index (C-index) and calibration plot.

RESULTS

Univariate and multivariate regression analysis identified stroke (95% CI, 0.575-5.954; P=0.022), hyperlipidemia (95% CI, 0.471-4.647; P=0.003), chronic suppurative otitis media (95% CI, 1.222-45.528; P=0.005), cervical spondylosis (95% CI, 1.232-3.017; P=0.005), and osteoporosis (95% CI, 1.130-3.071; P=0.001) were the independent risk factors for BPPV. These risk factors were used to construct a clinical predictive nomogram. The regression equation was: logit (P) = -6.820 + 0.450 * stroke + hyperlipidemia * 0.312 + chronic suppurative otitis media * 0.499 + cervical spondylosis * 0.916 + osteoporosis * 0.628. The calibration curves demonstrated excellent accuracy of the predictive nomogram. Decision curve analysis showed that the predictive model is clinically applicable when the threshold probability was between 20% and 60%.

CONCLUSIONS

Stroke, hyperlipidemia, chronic suppurative otitis media, cervical spondylosis and osteoporosis are independent risk predictors for BPPV. The developed nomogram is useful in predicting the risk of BPPV.

Anxiety characteristics in benign paroxysmal positional vertigo: first vs. recurrent episodes

PURPOSE

To assess the difference in state and trait anxiety levels in patients with Benign Paroxysmal Positional Vertigo (BPPV) at the first episode (FE) versus recurrent episodes (RE), before and after vestibular physiotherapy. A secondary objective was to assess the difference in the prevalence of underlying health conditions between FE and RE BPPV patients.

METHODS

Fifty-five patients with BPPV, aged 40-70, were recruited. The diagnosis of BPPV was confirmed based on subjective complaints of vertigo and positive results from the Dix-Hallpike and Supine Roll tests. Twenty-four patients were in their FE, and 31 had RE. All patients completed the State-Trait Anxiety Inventory (STAI) questionnaire three times; before, immediately after, and a week after vestibular physiotherapy treatment.

RESULTS

The RE group demonstrated higher trait anxiety than the FE group in all testing points: before treatment (median value of 38 versus 29, p-value = 0.02), immediately after treatment (median value of 36 versus 28, p-value < 0.01) and a week later (median value of 38 versus 28, p-value < 0.01). State anxiety decreased immediately after treatment in both groups, but at the second session, it was significantly higher in the RE than in the FE group (median value of 38 versus 28.5, p-value = 0.03). Hypothyroidism was significantly more frequent in the RE group (RE 16%, FE 0%, p-value = 0.04).

CONCLUSIONS

Based on the current study's findings, we recommend assessing anxiety levels in patients with recurrent BPPV and consider referring them for appropriate treatment when necessary.

Association between vitamin D deficiency and benign paroxysmal positional vertigo (BPPV) incidence and recurrence: a systematic review and meta-analysis

OBJECTIVES

The objective of this study is to determine the relationship between serum vitamin D level and the risk of developing benign paroxysmal positional vertigo (BPPV) incidence and recurrence in countries in the Northern Hemisphere.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed, Scopus and Web of Science databases were searched for studies published between January 2000 and February 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Participants located in the Northern Hemisphere aged 18 or over with at least one episode of BPPV, serum 25-hydroxyvitamin D levels measured and reported, no comorbidities or history of vitamin D supplementation.

DATA EXTRACTION AND SYNTHESIS

Data extraction and synthesis were performed by a single reviewer and checked by a second reviewer. Inclusion and exclusion criteria and risk of bias were assessed by two independent reviewers using the Newcastle Ottawa Tool for Cohort studies and Risk of Bias Assessment Tool for Nonrandomised Studies checklist for case-control studies. Meta-analysis was conducted using random effects models. Standard mean difference with a 95% CI was used to measure the relationship between vitamin D level and BPPV.

RESULTS

The 35 articles identified by the literature search reported data of 9843 individuals. 19 studies (7387 individuals) were included in the BPPV incidence meta-analysis while 7 studies (622 individuals) were included in the BPPV recurrence meta-analysis. Lower serum vitamin D levels were found in BPPV incidence compared with controls, but the relationship between vitamin D levels in recurrent BPPV compared with non-recurrent disease remained uncertain.

CONCLUSION

Results of this systematic review and meta-analysis demonstrated a negative correlation between serum vitamin D and BPPV incidence, while any relationship between serum vitamin D and BPPV recurrence remained uncertain. Risk of bias analysis revealed evidence of variable quality. There were insufficient data available to evaluate seasonal relationships between serum vitamin D and BPPV. Given the potential for this as a confounding factor, future research should aim to investigate this further.

PROSPERO REGISTRATION NUMBER

CRD42021271840.

No genetic causality between obesity and benign paroxysmal vertigo: A two-sample Mendelian randomization study

Objective

We applied Mendelian randomization to explore the causal relationship between obesity and benign paroxysmal vertigo (BPV).

Methods

We chose two types of obesity diseases. Obesity due to excessive calories and other or unspecified obesity from the FinnGen database. We used genomic significance (p < 5 × 10-8) to obtain independent single nucleotide polymorphisms (SNPs) as instrumental variables. Similarly, genome-wide association study data for the disease BPV were selected from the FinnGen database. R was then used to test the data for multiplicity and heterogeneity, as well as to detect the effect of individual SNPs on the results. Random effects inverse variance weighting was used as the main statistical analysis.

Results

First, by analyzing, we found an outlier in obesity due to excessive calories (rs12956821). Outliers were then removed, and the statistical results were analyzed without heterogeneity (p > 0.05) and horizontal pleiotropy (p > 0.05), as well as individual SNPs having no effect on the results. Meanwhile, random-effects IVW results showed obesity due to excessive calories (p = 0.481; OR = 0.941), and other or unspecified obesity (p = 0.640; OR = 0.964).

Conclusions

The present study did not find a causal relationship between the above two obesity types and BPV at the genetic level.

A Rare Presentation of Multicanal Benign Paroxysmal Positional Vertigo in a Premenopausal Woman With Osteopenia: A Case Report

We report a case of non-traumatic, multicanal benign paroxysmal positional vertigo (BPPV) in a premenopausal, osteopenic 35-year-old female with corresponding low bone mineral density. Dix-Hallpike and supine roll tests confirmed unilateral posterior canal (PC) BPPV from 2012-2014, and later, a rare presentation of multicanal BPPV with specifically ipsilateral horizontal canals (HC) and anterior canals (AC) affected in 2015. Heel scans displayed T-scores within the osteopenia range in 2012 until levels normalized one year later. Despite treatment with indicated canalith repositioning treatments (CRTs), symptoms continued to persist. Complete resolution of symptoms occurred in 2016, which is most likely due to self-treatment with daily 5000 IU vitamin D in 2015. This case emphasizes the rare presentation of unilateral single-canal BPPV to multi-canal BPPV, along with the importance of vitamin D treatment in preventing the recurrence of symptoms.

Vitamin D Deficiency and the Risk of Recurrent Benign Paroxysmal Positional Vertigo

Background Benign paroxysmal positional vertigo (BPPV) is the most common cause of positional vertigo. It is a short-lived (seconds) rotatory attack of vertigo in relation to the position of the head. Vitamin D deficiency may be one of the causes leading to BPPV. As there is no relevant local study from Iraq, this study aimed to evaluate the association between BPPV and vitamin D deficiency. Methodology This retrospective, case-control study was conducted at the otolaryngology clinic of Al-Ramadi Teaching Hospital during a 26-month duration. The study included 40 patients clinically diagnosed with BPPV and 80 individuals as controls. Detailed information regarding the demographic and clinical characteristics was obtained from each participant. Serum vitamin D and calcium levels were measured for each participant. Results Both cases and controls were matched regarding age and gender. Serum vitamin D level in cases (15.458 ± 6.14 ng/mL) was lower than controls (23.604 ± 12.58 ng/mL), with a p-value of 0.0001 and large clinical effect size (0.8). Vitamin D deficiency was found in 35 cases and 37 controls, with a highly significant difference (p = 0.0001) and an odds ratio of 8.135. Vitamin D deficiency in BPPV patients with recurrence (12.615 ± 4.096 ng/mL) was lower than those without recurrence (18.3 ± 6.611 ng/mL), with a highly significant difference (p = 0.002) and small clinical effect size (0.3). Older age and vitamin D deficiency were risk factors for recurrence according to the multinominal logistic regression test (p < 0.05). Conclusions Vitamin D deficiency might cause the occurrence and recurrence of BPPV. Older age might be a risk factor for BPPV recurrence.

Geriatric benign paroxysmal positional vertigo: a single-center study

OBJECTIVE

To compare the clinical features, risk factors, distribution of Benign Paroxysmal Positional Vertigo (BPPV) subtypes, and effectiveness of canalith repositioning between geriatric and non-geriatric patients with BPPV.

METHODS

A total of 400 patients with BPPV were enrolled. Canalith repositioning was performed according to the semicircular canals involved. Patients were divided by age into a geriatric group (≥60 years) and a non-geriatric group (20-59 years). Clinical characteristics, potential age-related risk factors, distribution of subtypes, and effectiveness of canalith repositioning were compared between the groups.

RESULTS

Female sex was significantly more common in all age groups, with a peak female-to-male ratio of 5.1:1 in the group aged 50-59 years. There was a higher proportion of men in the geriatric group. A history of disease associated with atherosclerosis was significantly more common in the geriatric group (p < 0.05). Migraine was significantly more common in the non-geriatric group (p = 0.018), as was posterior canal BPPV. The horizontal canal BPPV (especially horizontal canal BPPV-cupulolithiasis), and multicanal BPPV subtypes were more common in the geriatric group, whereas anterior canal BPPV was more common in the non-geriatric group. Two canalith repositioning sessions were effective in 58.0% of the geriatric cases and in 72.6% of the non-geriatric cases (p = 0.002). There was a tendency for the effectiveness of canalith repositioning to decrease with increasing age.

CONCLUSION

BPPV was more common in women. However, the proportion of men with BPPV increased with age. Elderly patients often had a history of diseases associated with atherosclerosis (i.e., hypertension, diabetes, and hyperlipidemia). The horizontal canal BPPV (particularly horizontal canal BPPV-cupulolithiasis) and multicanal BPPV subtypes were more common and the anterior canal BPPV subtype was less common in elderly patients. The effectiveness of canalith repositioning may decrease with age. Therefore, older patients should receive more comprehensive medical treatment.

LEVEL OF EVIDENCE: 4

Cerebral Outflow Discrepancies in Recurrent Benign Paroxysmal Positional Vertigo: Focus on Ultrasonographic Examination

This prospective pilot study aimed to evaluate whether cerebral inflow and outflow abnormalities assessed by ultrasonographic examination could be associated with recurrent benign paroxysmal positional vertigo (BPPV). Twenty-four patients with recurrent BPPV, affected by at least two episodes, and diagnosed according to American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria, evaluated at our University Hospital, between 1 February 2020 and 30 November 2021, have been included. At the ultrasonographic examination, 22 of 24 patients (92%) reported one or more alterations of the extracranial venous circulation, among those considered for the diagnosis of chronic cerebrospinal venous insufficiency (CCSVI), although none of the studied patients were found to have alterations in the arterial circulation. The present study confirms the presence of alterations of the extracranial venous circulation in recurrent BPPV; these anomalies (such as stenosis, blockages or regurgitation of flow, or abnormal valves, as per the CCSVI) could cause a disruption in the venous inner ear drainage, hampering the inner ear microcirculation and then possibly causing recurrent otolith detachment.

Assessment of Osteoporosis and Vitamin D3 Deficiency in Patients with Idiopathic Benign Paroxysmal Positional Vertigo (BPPV)

Background and objectives: Osteoporosis and vitamin D3 deficiency may be risk factors of benign paroxysmal positional vertigo (BPPV). The aim of this study was to assess the prevalence of osteoporosis and 25(OH) vitamin D3 deficiency in a group of patients with idiopathic benign paroxysmal positional vertigo. Materials and Methods: Thirty-five patients (twenty-eight women and seven men) with posterior semicircular canal BPPV were enrolled in the study. The subjects underwent hearing assessment (tonal audiometry and impedance audiometry) and the Dix-Hallpike maneuver. Serum 25(OH) vitamin D3 levels were determined and lumbar spine bone densitometry was performed. The relationships between sex, age, height, Body Mass Index (BMI), vitamin D3 levels and bone densitometry results were assessed. Results: The diagnosis of osteoporosis was confirmed in 1 patient (3%), 3 subjects were osteopenic (8.6%), and normal bone densitometry was found in 31 (88.6%) patients. Conclusions: We found no statistically significant relationships between age, BMI or vitamin D3 levels and bone densitometry results in patients with idiopathic BPPV.

Mixed Depression in the Post-COVID-19 Syndrome: Correlation between Excitatory Symptoms in Depression and Physical Burden after COVID-19

The relationship between depression and post-COVID-19 disease syndrome (post-COVID-19 syndrome) is established. Nevertheless, few studies have investigated the association between post-COVID-19 syndrome and mixed depression, i.e., a specific sub-form of depression characterized by high level of excitatory symptoms. Aims of the present study are: (a) to compare the post-COVID-19 syndrome's burden in depressed and non-depressed patients, and (b) to investigate the correlation between post-COVID-19 syndrome's burden and the severity of mixed depression. One thousand and forty six (n = 1460) subjects with post-COVID-19 syndrome were assessed. Subjects were divided into those with (DEP) or without (CONT) depression. Sociodemographically, post-COVID-19 syndrome's symptoms number and type were compared. In DEP, association between levels of excitatory symptoms and the presence of post-COVID-19 syndrome's symptoms were additionally assessed. DEP showed greater percentages of family history of psychiatric disorders than CONT. DEP showed higher percentages of post-COVID-19 symptoms than CONT. A greater level of excitatory symptoms were associated to higher frequencies of post-COVID-19 syndrome' symptoms. Higher levels of post-COVID-19 syndrome's symptoms in DEP corroborate the evidence of a common pathway between these two syndromes. Presence of excitatory symptoms seem to additionally add a greater illness burden. Such findings might help clinicians choose the appropriate treatment for such states. More specifically, therapies aimed to treat excitatory symptoms, such as antipsychotics and mood stabilizers, might help reduce the illness burden in post-COVID-19 patients with mixed depression.

Evaluation of a questionnaire as a screening tool for benign paroxysmal position vertigo

OBJECTIVE

To determine the value of a questionnaire as a screening tool for benign paroxysmal position vertigo (BPPV).

STUDY DESIGN

Retrospective chart review.

SETTING

Tertiary care centers.

METHODS

A total of 520 vertigo adults completed the questionnaire before the diagnosis was confirmed. After vestibular function examination and other diagnostic examination, the diagnosis of all participants was confirmed by experts. By validating valuable items from the questionnaire with 47 items, a new questionnaire of 5 items was formed to quickly diagnose BPPV. The internal consistency of the new questionnaire and validity were evaluated. The correlation between the score obtained from the new questionnaire and diagnosis was investigated. The mean score was also compared between groups with and without BPPV and diagnostic precision measures were calculated.

RESULTS

520 vertigo participants answered all the question completely and BPPV was identified in 138 participants (26.5%). The responses to questionnaire revealed preferable reproducibility (r = 0.898, P < 0.05) and internal consistency (Cronbach's α = 0.702) as well as the validity (Kaiser-Meyer-Olkin, KMO = 0.731). The higher the individual score, the more likely to be BPPV (B = 2.082; P < 0.05). The mean score of answers was greater in the group with a clinical diagnosis of BPPV compared to those without BPPV (F = 58.459, P < 0.05). The sensitivity of the screening tool was 92.8% and specificity was 88.5%, with an area under the ROC curve of 0.946 (95% confidence interval 0.926-0.965; P < 0.05).

CONCLUSION

The questionnaire proved to be of great value to screen for individuals with possible BPPV.

Recurring benign paroxysmal positional vertigo after successful canalith repositioning manoeuvers

Benign baroxysmal positional vertigo (BPPV) represents the most common peripheral vestibular dysfunction encountered in clinical practice. Although canalith repositioning procedures (CRPs) are a relatively successful treatment for BPPV, many patients suffer from recurrences. Several studies have demonstrated that various pathological conditions (diabetes, hypertension, endolymphatic hydrops, low vitamin D levels) as well as delayed BPPV treatment using CRP, multiple canal involvement may be associated with recurrence of BPPV. We evaluated the history of 1,428 patients (558 males and 870 females, age range 10-92 years) suffering from BPPV. Of 1,428 cases, 820 (77%) did not relapse in the following 20 years. Mean age and gender did not differ significantly between groups with and without recurrence. Regarding risk factors for BPPV recurrence, age, female gender, migraine, hypertension, diabetes mellitus, hyperlipidaemia, osteoporosis, vascular diseases, and vitamin D deficiency may be associated with recurrent BPPV and should be kept in mind. Osteoporosis, vitamin D deficiency as well as thyroid dysfunction should be evaluated in postmenopausal women. Treatment of these comorbidities may help to reduce the risk of BPPV recurrence.

The relationship between psychological conditions and recurrence of benign paroxysmal positional vertigo: a retrospective cohort study

BACKGROUND

Psychological conditions have been found to be associated with an increased risk of incident benign paroxysmal positional vertigo (BPPV). However, much less is known on whether and how psychological conditions such as anxiety, insomnia and obsessive-compulsive disorder (OCD) affect the recurrence of BPPV.

METHODS

A retrospective cohort study of 2,612 outpatients and inpatients diagnosed with BPPV between September 2012 and August 2020. BPPV recurrence was followed up until February 2021. The Cox proportional hazard regression was used to analyze the association between psychological conditions and the risk of the first recurrence. Poisson regression was applied to analyze the association between psychological conditions and the number of recurrences in patients with at least one relapse.

RESULTS

During the follow-up, 391 patients had at least one BPPV recurrence. Female BPPV patients were more likely than male patients to experience relapses than male patients, but the characteristics of BPPV recurrence (number of recurrences and duration between recurrences) did not differ between men and women. After adjustment for sex, age and comorbidities, a heightened risk of first BPPV recurrence was found to be associated with anxiety (hazard ratio [HR]: 1.30, 95% confidence interval [CI]: 1.01, 1.68) and OCD (HR: 2.15, 95% CI: 1.31, 3.52). An increased risk of first BPPV recurrence associated with insomnia was only observed in male patients (HR: 2.22, 95% CI: 1.24, 3.98) but not in female patients (HR: 0.91, 95% CI: 0.63, 1.31). None of these psychological conditions were associated with the number of recurrences in patients who experienced recurrence.

CONCLUSIONS

The presence of anxiety and OCD increased the risk of first BPPV recurrence, as well as insomnia for male patients. These psychological conditions were not associated with the number of BPPV recurrences. Diagnosis and treatment of these psychological conditions could be a useful strategy to prevent the recurrence of BPPV.

Correlation between serum vitamin D level and benign paroxysmal positional vertigo recurrence

OBJECTIVE

Benign paroxysmal positional vertigo (BPPV) is the most common cause of dizziness in the general population. BPPV is known to be closely related to the serum vitamin D level. This study aimed to examine the relationship between serum vitamin D levels and BPPV recurrence.

METHODS

A retrospective chart review was conducted on 50 patients diagnosed with posterior and lateral canal BPPV. The diagnosis of BPPV was based on the finding of vertigo and nystagmus induced by certain head positions (The Dix-Hallpike maneuver and head roll tests). The patients were classified into BPPV recurrence (Group A) and non-recurrence groups (Group B). Otolith function was assessed by cervical vestibular evoked myogenic potential (cVEMP) and ocular vestibular evoked myogenic potential (oVEMP), and their association with vitamin D levels was evaluated.

RESULTS

There were 19 subjects in Group A and 31 in Group B. There were no significant differences in age, sex, cVEMP, and oVEMP between the two groups. The average vitamin D level was 12.9 ± 8.0 ng/mL for Group A and 19.2 ± 8.2 ng/mL for Group B, and the difference between the groups was significant (p = 0.011). In the receiver operating characteristic curve analysis for BPPV recurrence with the best sensitivity and specificity, the optimal cut-off value of total serum vitamin D was determined as 12.74 ng/mL. Furthermore, reclassifying the patients based on the cut-off value showed a significantly higher recurrence rate in the group with a lower serum vitamin D level (70.5% vs. 22.5%, p = 0.007).

CONCLUSION

This complex finding highlights the importance of measuring serum vitamin D levels to monitor and evaluate patients at risk of BPPV recurrence.

Seven years of experience with treatment of benign paroxysmal positional vertigo with a mechanical rotational chair

Background

Throughout the last decade, several mechanical rotational chairs have been developed for diagnostics and treatment of patients with a typical case history of benign paroxysmal positional vertigo. Sparse evidence, however, exists in terms of diagnostic accuracy and treatment efficiency with these mechanical rotational chairs. Also, recommendations for optimal use of these chairs are yet to be determined.

Objective

Primary objective was to evaluate overall treatment of benign paroxysmal positional vertigo with a mechanical rotational chair and secondary objectives included description of patient- and BPPV characteristics, determination of subjective and objective outcomes, as well as analyzation of recurrence- and recurrence-related risk factors following successful treatment.

Methods

Retrospective cohort study with 635 patients diagnosed with benign paroxysmal positional vertigo and treated by means of a mechanical rotational chair during a 7-year period from 2014 to 2021 at a tertiary University hospital. Patient- and disease-specific characteristics, treatment and recurrence data were collected through reviewing of patient records.

Results

The mean number of required treatments was 2.7 when accounting for a six percent treatment failure rate (defined as a need of more than 10 treatments), and 3.7 when not. Bilateral mono-canal affection required 3.8 treatments, unilateral multi-canal 3.5 treatments, and the combination of bilateral and multi-canal affection 5.2 treatments. All these scenarios were associated with significantly higher numbers of required treatments when compared to unilateral mono-canal affection, which required 1.9 treatments. The overall recurrence rate was 25.4 percent.

Conclusion

A mechanical rotational chair provides successful treatment of benign paroxysmal positional vertigo. Mechanical rotational chairs should primarily be reserved for the treatment of retractable and atypical benign paroxysmal positional vertigo patients. Many aspects of the optimal use of these chairs still require elaborative assessment.

Risk factors for residual dizziness in patients with benign paroxysmal positional vertigo after successful repositioning: a systematic review and meta-analysis

PURPOSE

To investigate the risk factors for residual dizziness (RD) in patients with benign paroxysmal positional vertigo (BPPV) after successful repositioning.

METHODS

Searches were performed in PubMed, Embase, Cochrane library, Web of Science, Chinese National Knowledge Infrastructure, and Sino Med up to March 7, 2021 and references of relevant articles were screened. Data from eligible studies were meta-analyzed using Stata version 16.0 and Review Manager 5.4.

RESULTS

In this systematic review and meta-analysis of 4487 patients from 31 studies, the prevalence of RD was 43.0% (95% CI 39.0-48.0%). Age (MD 4.17; 95% CI 2.13-6.21, P = 0.000), female gender (OR = 1.28, 95% CI 1.11-1.47, P = 0.001), secondary BPPV (OR 1.88; 95% CI 1.27-2.77, P = 0.001), a longer duration of BPPV before treatment (MD 3.45; 95% CI 1.87-5.02, P = 0.000), abnormal ocular vestibular evoked myogenic potential (OVEMP, OR 4.34; 95% CI 2.78-6.78, P = 0.000), abnormal cervical vestibular evoked myogenic potential (CVEMP, OR 2.48; 95% CI 1.54-3.99, P = 0.000), higher Dizziness Handicap Index (DHI) score before treatment (MD 10.88; 95% CI 5.96-15.80, P = 0.000), anxiety (OR 9.58; 95% CI 6.32-14.52, P = 0.000), osteopenia (OR = 4.40, 95% CI 2.17-8.96, P = 0.000), onset in winter (OR 7.27; 95% CI 2.38-22.24, P = 0.001) and with a history of BPPV (OR 1.79; 95% CI 1.06-3.04, P = 0.03) are the risk factors for RD in patients with BPPV after successful repositioning. The affected side, location or type of semicircular involvement, hyperlipidemia, diabetes, hypertension, heart disease, migraine, sleep disorders, canalolithiasis/cupulolithiasis, the number of times the canalith repositioning procedures (CRPs) were performed and number of vertigo attacks did not correlate with the occurrence of RD.

CONCLUSIONS

Despite successful treatment, nearly half of the BPPV patients developed RD. RD seems to be a syndrome caused by multiple factors. The pathogenesis of most factors can be explained by psychological and/or physical disorders. Early recognition of these risk factors contributes to the prevention and treatment of RD.

Risk Factors for Recurrence of Benign Paroxysmal Positional Vertigo. A Clinical Review

Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular dysfunctions encountered in clinical practice. Although the treatment of BPPV is relatively successful, many patients develop recurrence after treatment. Our purpose is to evaluate the mean recurrence rate and risk factors of BPPV after treatment. A review of the literature on the risk factors of BPPV recurrence was performed. A thorough search was conducted using electronic databases, namely Pubmed, CINAHL, Academic Search Complete and Scopus for studies published from 2000 to 2020. Thirty studies were included in this review with 13,358 participants. The recurrence rate of BPPV ranged from 13.7% to 48% for studies with follow-up <1 year, and from 13.3% to 65% for studies with follow-up ≥2 years. Pathophysiologic mechanisms and implication of each of the following risk factors in the recurrence of BPPV were described: advanced age, female gender, Meniere’s disease, trauma, osteopenia or osteoporosis, vitamin D deficiency, diabetes mellitus, hypertension, hyperlipidemia, cardiovascular disease, migraine, bilateral/multicanal BPPV, cervical osteoarthrosis and sleep disorders. Patients with hyperlipidemia and hypertension had the highest recurrence rates of BPPV, 67.80% and 55.89%, respectively, indicating that vascular comorbidities increase the risk of BPPV recurrence. In addition, more than half of patients (53.48%) with diabetes mellitus and BPPV experienced recurrence of BPPV. Knowledge and awareness of risk factors for recurrence of BPPV are essential for the assessment and long-term prognosis of patients. Identification of these relapse risk factors may enhance the ability of clinicians to accurately counsel patients regarding BPPV and associated comorbidities.

Current Insights into Treating Vertigo in Older Adults

The number of older people has been increasing over recent decades in Western populations. Dizziness, imbalance, and vertigo constitute some of the most common complaints in older patients, and risk of falling is the most frequent and worrying consequence. It has been reported that 15–20% of the adult population experiences these debilitating symptoms. Among the diseases that may be associated with vertigo, the three classes of otological, central, and functional (psychological) dizziness may be distinguished. Overall, vestibular disorders account for 48% of vertiginous complaints in the older population. The main focus of this article is to review the forms of pharmacotherapy for vertigo, especially with regard to older patients, who may be treated simultaneously with other drugs for different comorbidities. Interactions with other drugs should be considered in the choice of a particular course of treatment. Moreover, overuse of pharmacotherapy for the management of vertigo in the elderly may prevent the development of the central compensatory mechanism that sustains both static and dynamic imbalance after a vertiginous crisis. In the majority of patients, vestibular and physical rehabilitation are strongly advised and rarely contraindicated.

Clinical effect of vestibular rehabilitation on benign paroxysmal positional vertigo: A protocol for systematic review

BACKGROUND

This study will evaluate the clinical effect of vestibular rehabilitation (VR) on benign paroxysmal positional vertigo (BPPV).

METHODS

In this study, we will identify relevant trials on the topic published in MEDLINE, EBASE, Web of Science, Cochrane Library, Scopus, CINAHL, CBM, and CNKI from inception to the present. We will also search conference proceedings, thesis/dissertation, ongoing trials in clinical trial registry, and reference lists of included studies. Two researchers will independently carry out record selection, data extraction, and study quality assessment, respectively. Any disagreement will be arbitrated and solved with the help of a third researcher. If necessary, we will conduct random-effects meta-analysis to pool the effect estimates of included trials determined to be acceptable heterogeneity.

RESULTS

We will summarize the latest evidence to assess the effect of VR for the treatment of patients with BPPV.

CONCLUSION

The findings of this study will help determine whether or not VR is effective in treating BPPV.

OSF REGISTRATION

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