BPPV presentation in ENT clinics is variable. The objective of this study was to examine differences in demographic and clinical features, as well as treatment outcomes, between classic objective BPPV (O-BPPV) and subjective BPPV (S-BPPV). Unlike classic BPPV (with nystagmus), several patients experience vertigo and accompanying autonomic symptoms without nystagmus. This type of disease has been characterised as S-BPPV and, although not rare, has not been extensively studied in the past. The aim of this study was to investigate the clinical outcomes of a group of patients diagnosed with and treated for S-BPPV and to compare the outcomes with those of patients with O-BPPV. One hundred and thirty-four medical records of patients with BPPV during the past five years were reviewed for demographic characteristics with records of past medical history, associated symptoms, response to CRMs, interval between symptom onset and the first medical visit, and recurrence rate. The O-BPPV group (n=101) comprised patients who experienced vertigo and accompanying autonomic symptoms, and showed typical nystagmus. The S-BPPV group (n=33) comprised patients who, when subjected to a provoking manoeuvre, showed all of the classic BPPV symptoms but did not show nystagmus.
All patients had at least three years of follow-up. The conclusions of the study were that a diagnosis of positional nystagmus is not essential for considering CRMs. This study supports the use of CRMs as the primary treatment for S-BPPV and O-BPPV.
The results were interesting and the demographics (age and sex ratio), past medical history, and associated symptoms were not significantly different between the two groups. Posterior semi-circular canal BPPV appeared more than twice as often as horizontal semi-circular canal BPPV in patients with S-BPPV. Overall improvement was better in O-BPPV than in S-BPPV; however, there was no significant difference. The total numbers of manoeuvres for recovery and the interval between symptom onset and the first medical visit also did not show any significant inter-group differences. During a three-year follow-up, the recurrence rate was 13.8% for O-BPPV and 21.2% for S-BPPV. In conclusion this study reinforces that subjective BPPV patients should be offered CRMs similar to the objective group as the results do seem to benefit equally (with no statistically significant difference). This we assume, reflects current practice.
