Characteristics of recurrent BPPV

Clinical Characteristics of persistent geotropic horizontal direction-changing positional nystagmus: Experience in 189 participants

BACKGROUND

The etiology and mechanism of persistent geotropic horizontal direction-changing positional nystagmus (DCPN) are still unclear. Whether this pattern of nystagmus is a subtype of benign paroxysmal positional vertigo (BPPV) remains controversial.

OBJECTIVE

The goal of this study was to observe the clinical characteristics of persistent geotropic horizontal DCPN involving the lateral semicircular canal.

METHODS

The analysis was performed to participants with episodic positional vertigo in our clinic from 2014 to 2021. Participants were included via positional test. We observed and summarized the distribution data, vertigo history, follow-up tests, and recurrence situations of 189 persistent geotropic horizontal DCPN participants.

RESULTS

The mean age at the first time showing of persistent geotropic horizontal DCPN was 56±14.7 and more women than men were affected by persistent geotropic horizontal DCPN (female-to-male ratio 2.4 : 1). Overall, 58.7% (57/94) of participants who came for the first-week follow-up test were asymptomatic. Thirty-three participants experienced recurrence (female-to-male ratio: 4.5 : 1). Fifty-three (28.0%) participants experienced the conversion of the patterns of DCPN in the history, the follow-up tests and the recurrence compared to the first showing of persistent geotropic horizontal DCPN. 24(12.1%) participants still experienced persistent geotropic horizontal DCPN attack in the follow-up tests and the recurrences without benign paroxysmal positional vertigo history.

CONCLUSION

Persistent geotropic horizontal DCPN affected more women than men. The persistent geotropic horizontal DCPN that with conversion to transient geotropic horizontal DCPN or to persistent apogeotropic horizontal DCPN might be a subtype of BPPV or in a stage of BPPV process. However, the persistent geotropic horizontal DCPN without conversion might be an independent disease that is not related to BPPV.

Recurrence in patients with benign paroxysmal positional vertigo of the lateral semicircular canal

OBJECTIVES

There are 3 subtypes of lateral canal benign paroxysmal positional vertigo. Persistent geotropic positional nystagmus is due to a light cupula, heavy cupula produces apogeotropic positional nystagmus, and canalolithiasis accounts for transient geotropic positional nystagmus. The aims of this study were to determine the recurrence rate and to examine the number of times of recurrence in each of the 3 subtypes.

METHODS

Subjects were patients with light cupula (n = 47), heavy cupula (n = 48), and canalolithiasis (n = 45). We investigated the number of times of recurrence and determined the subtypes of a recurrent vertigo attack over the period of 5 years.

RESULTS

The subtype of a recurrent vertigo attack was not always the same as the subtype at the first visit. The recurrence rate of light cupula group was 72.3%, that of heavy cupula group was 20.8%, and that of canalolithiasis group was 28.9%. Some patients experienced recurrence more than once. The mean value and standard deviation of the number of times of recurrence in light cupula group was 2.5 ± 1.3 times, that in heavy cupula group was 1.5 ± 0.7 times, and that in canalolithiasis group was 1.5 ± 0.7 times.

CONCLUSIONS

The recurrence rate in patients with light cupula is much higher than that in patients with heavy cupula or canalolithiasis. The number of times of recurrence in patients with light cupula is greater than that in patients with heavy cupula or canalolithiasis.