Acle-Cervera Leticia, Carballo-Lahoz Leticia, Esteban-Sánchez Jonathan, Álvarez-Morujo-de-Sande María Guadalupe, Montilla-Ibáñez María Alharilla, Bécares-Martínez Carmen, González-Aguado Rocío, Rodríguez-Montesdeoca Isaura, Manrique-Huarte Raquel, Domènech-Vadillo Esther, Guerra-Jiménez Gloria, Domínguez-Durán Emilio
Hospital Universitario Infanta Leonor, Madrid, Spain.
Hospital Universitari Joan XXIII, Tarragona, Spain.
Eur Arch Otorhinolaryngol. 2025 Apr;282(4):1865-1877. doi: 10.1007/s00405-024-09094-x. Epub 2025 Jan 6.
Benign paroxysmal positional vertigo (BPPV) is a vestibular disorder causing recurrent episodes of vertigo. Despite symptom resolution at discharge, events such as relapses, migraines, neck pain, falls, and persistent postural-perceptual dizziness (PPPD) may occur. This study aims to estimate the incidence, timing, and risk factors for these symptoms.
This multicenter, prospective, observational study recruited patients with a first episode of BPPV. Patients were treated with canalith repositioning maneuvers and discharged when no nystagmus was observed. Follow-up included in-person and telephone assessments over one year. The incidence and timing of symptoms were calculated, and risk factors were identified through regression models.
201 patients were recruited, and 124 met the inclusion criteria. 70.97% experienced events after discharge, though symptoms were not always severe enough to seek medical care. No useful risk factors were found for predicting BPPV recurrence. Low vitamin D levels increased recurrence risk but did not effectively discriminate patients. Women were more likely to develop headaches. Prior headaches, migraines, or neck pain were the strongest predictors of future occurrences of these conditions. Headaches or neck pain themselves triggered vestibular symptoms, often indistinguishable from BPPV. BPPV was associated with new-onset neck pain. The risk of falls increased with age. Anxiety triggered by BPPV predicted PPPD. Developing symptoms after discharge increased the likelihood of other events.
Although BPPV is considered resolved when no nystagmus is observed during provocation tests, it should be understood as a condition accompanied by other symptoms that often persist after discharge in most patients.
良性阵发性位置性眩晕（BPPV）是一种导致反复发作性眩晕的前庭疾病。尽管出院时症状得到缓解，但仍可能发生复发、偏头痛、颈部疼痛、跌倒以及持续性姿势性知觉性头晕（PPPD）等情况。本研究旨在评估这些症状的发生率、发生时间及危险因素。
这项多中心、前瞻性观察性研究招募了首次发作BPPV的患者。患者接受了耳石复位手法治疗，在未观察到眼球震颤时出院。随访包括为期一年的面对面和电话评估。计算症状的发生率和发生时间，并通过回归模型确定危险因素。
共招募了201例患者，其中124例符合纳入标准。70.97%的患者在出院后出现了相关情况，不过症状并非总是严重到需要就医。未发现预测BPPV复发的有效危险因素。低维生素D水平会增加复发风险，但不能有效区分患者。女性更易出现头痛。既往有头痛、偏头痛或颈部疼痛是这些情况未来再次发生的最强预测因素。头痛或颈部疼痛本身会引发前庭症状，通常与BPPV难以区分。BPPV与新发颈部疼痛有关。跌倒风险随年龄增加而升高。BPPV引发的焦虑可预测PPPD。出院后出现症状会增加其他事件发生的可能性。
尽管在激发试验中未观察到眼球震颤时BPPV被认为已缓解，但应将其理解为一种伴有其他症状的疾病，在大多数患者中，这些症状在出院后往往会持续存在。
