Clinical features of recurrent or persistent benign paroxysmal positional vertigo.

OBJECTIVES: To identify clinical features and causes of recurrent or persistent benign paroxysmal positional vertigo (BPPV) and to analyze the effectiveness of frequently repeated canalith repositioning procedures (CRPs).

STUDY DESIGN: Case series with chart review.

SETTING: Academic university hospital.

METHODS: The authors retrospectively reviewed the clinical records of 120 patients who were diagnosed with BPPV at the Dizziness Clinic in Ajou University Hospital, Korea, between 2004 and 2008. "Persistent" and "recurrent" BPPV were respectively defined as BPPV continuing more than 2 weeks and recurring BPPV in the same canals after at least 2 weeks of a symptom-free interval following previous successful treatments. The authors treated patients with frequently repeated CRPs such as the modified Epley maneuver or a barbecue rotation every 2 or 3 days in the outpatient clinic.

RESULTS: Among 120 patients with BPPV, 93 (77.5%) were typical, 15 (12.5%) were persistent, and 12 (10.0%) were recurrent. Although the most common cause was idiopathic in both recurrent and persistent BPPV, secondary causes, including trauma, were much more common in recurrent and persistent BPPV than in typical BPPV. Typical and recurrent BPPV developed most commonly in the posterior semicircular canals. Persistent BPPV was most commonly detected in the lateral semicircular canals. After frequently repeated CRPs, 91.7% and 86.7% of the patients with recurrent or persistent BPPV, respectively, had resolution of nystagmus and vertigo.

CONCLUSION: Recurrent and persistent BPPV are not rare diseases and occur with a higher incidence than expected, especially in patients with secondary causes. However, they can be successfully treated with frequently repeated CRPs.