It is an observation that BPPV appears to be commonly associated with Meniere’s disease (MD). This five-year study compared features and treatment outcomes between patients presenting with MD in conjunction with unilateral BPPV and a group of BPPV patients without MD. Of the 120 patients presenting with BPPV, 21 had Meniere’s disease. Eight of the MD patients had multiple canal BPPV (Group A) and 13 had single canal BPPV (Group B). Group C, also acting as controls, consisted of the 99 patients with what the authors referred to as idiopathic BPPV. In all groups, posterior canal BPPV was the most common. There was more multiple canal involvement in the MD group than the controls (38.1% vs. 7.1%). In all groups, multiple treatment sessions were required to achieve a cure. Overall treatment success rate was 76.2% for the MD group and 83.8% for controls. The difference was not statistically significant. However, recurrence at six months was statistically significant: 50% in the MD group vs. 20.2% controls (p <0.05) particularly for horizontal canal BPPV. The conclusions were puzzling as most were not backed by the statistical data. The authors stated that BPPV in MD differs from that of idiopathic BPPV in the sense a) duration of symptoms is longer, b) posterior canal is more frequently involved, c) caloric canal paresis is more frequent, d) treatment outcome is poorer and e) recurrence rate is higher. However, statistical data in the text only support conclusions c and e. The idiopathic group could well have included patients with a previous history of vestibular neuritis/labyrinthitis considering 22% had caloric canal paresis. There was no mention that vestibular neuritis was excluded. A significant finding of multiple canal BPPV in the MD group was perhaps the key finding in the study but the reasons why were not addressed.

Benign paroxysmal positional vertigo associated with Meniere’s disease.
Zhu M, Yu F, Zhou F, et al.
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Victor Osei-Lah

Bournemouth, UK.

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