BPPV duration as a predictor for therapy
Reviewed by Sunil Sharma

Benign paroxysmal positional vertigo (BPPV) is one of the most common vestibuar disorders encountered in the neurotology clinic. The majority of cases of BPPV are due to vestibuar lithiasis in the posterior semicircular canal, but there are reports of cases involving the lateral semicircular canal, or more rarely, the superior semicircular canal. There are excellent results in terms of resolution of symptoms with canalith repositioning techniques, but there is a group of patients who don’t respond to treatment, and require repeated manoeuvers, or who develop rapid recurrence of their symptoms after initial successful treatment. The authors in this Greek study attempted to determine if duration of BPPV had a prognostic impact on resolution of symptoms. They performed a retrospective study of all patients diagnosed with posterior semicircular canal BPPV over a three-year period, and split the patients into two groups; those who had BPPV of recent onset (<4 weeks, n=110) and those who had longer duration of BPPV at presentation (>4 weeks, n=121). The outcome of treatment was similar in both groups, but the rate of recurrence of symptoms was significantly higher in those patients with BPPV of longer duration (21.5% vs 10%). The authors postulate that the reason for the higher rate of recurrence may be due to the higher mean age of the group with BPPV of longer duration (58.2 vs 51.3 years), causing more extensive degenerative changes in the inner ear of the older patients. These findings may have implications in the follow-up for patients who report a longer duration of BPPV at initial presentation, as they may be more susceptible to recurrence of symptoms. 

Duration of benign paroxysmal positional vertigo as a predictor for therapy.
Balatsouras DG, Aspris A, Ganelis P, et al.
B-ENT
2015;11:199-203