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Dizziness handicap and clinical characteristics of posterior and lateral canal BPPV

European Archives of Oto-Rhino-Laryngology volume 276, pages 2181–2189 (2019)Cite this article

Abstract

Purpose

Benign paroxysmal positional vertigo (BPPV) is diagnosed and divided into subtypes based on positioning vertigo and nystagmus. Whether these subtypes entail any significant differences in patient-reported symptoms; is yet not known. Such differences may have clinical and therapeutic consequences. Our aim was to assess dizziness handicap and clinical characteristics of posterior and lateral canal BPPV.

Methods

This prospective observational multicentre study analysed consecutive patients with BPPV, confirmed by standardized procedures including videonystagmography under diagnostic manoeuvres in a biaxial rotational chair. Patients were screened for other neurological and otological disorders.

Outcomes

Dizziness handicap inventory (DHI), posterior vs. lateral canal involvement. Factors: age, gender, positional nystagmus intensity (maximum slow-phase velocity), symptom duration, 25-hydroxyvitamin D-level and traumatic aetiology.

Results

132 patients aged 27–90 (mean 57, SD 13) years were included. Higher DHI scores were associated with lateral canal BPPV [95% CI (1.59–13.95), p = 0.01] and female gender [95% CI (0.74–15.52), p = 0.03]. Lateral canal BPPV was associated with longer symptom duration [OR 1.10, CI (1.03–1.17), p = 0.01] and lower 25-hydroxyvitamin D-levels [OR 0.80, CI (0.67–0.95), p = 0.03]. There was no correlation between DHI scores and nystagmus intensity.

Conclusions

This study suggests that patients with lateral canal BPPV have increased patient-perceived disability, lower vitamin D-levels and longer duration of symptoms. This subtype might therefore require closer follow-up. Patient-perceived disability is not related to positional nystagmus intensity.

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Acknowledgements

Thanks to the employees at the department of Otorhinolaryngology, Head and Neck Surgery, Haukeland, Bergen who have been helping me with the logistics. Special thanks to my cherished colleague Elisabeth Torkildsen, for her invaluable help with managing the collection and registration of data, and to Rolf Gjestad for his support of great value in data analysis.

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The authors have no funding and relationships.

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Authors and Affiliations

  1. Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Haukeland University Hospital, 5021, Bergen, Norway

    Camilla Martens, Frederik Kragerud Goplen, Torbjørn Aasen & Stein Helge Glad Nordahl

  2. Department of Clinical Medicine, University of Bergen, Bergen, Norway

    Camilla Martens, Frederik Kragerud Goplen & Stein Helge Glad Nordahl

  3. Department of Otorhinolaryngology and Head and Neck Surgery, Oslo University Hospital, Oslo, Norway

    Karl Fredrik Nordfalk

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  1. Camilla Martens
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  2. Frederik Kragerud Goplen
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Correspondence to Camilla Martens.

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Martens, C., Goplen, F.K., Aasen, T. et al. Dizziness handicap and clinical characteristics of posterior and lateral canal BPPV. Eur Arch Otorhinolaryngol 276, 2181–2189 (2019). https://doi.org/10.1007/s00405-019-05459-9

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