Clinical Report: Identifying Risk Factors for Refractory BPPV
Overview
This study investigates the clinical factors associated with refractory benign paroxysmal positional vertigo (BPPV), focusing on serum 25-hydroxyvitamin D levels and BPPV subtype. It finds that lower serum 25(OH)D levels are associated with treatment resistance, particularly in typical BPPV cases.
Background
Benign paroxysmal positional vertigo (BPPV) is a prevalent cause of acute vertigo, typically treated with canalith repositioning procedures (CRPs). However, some patients experience refractory BPPV, requiring multiple CRP attempts. Understanding the factors contributing to treatment resistance is crucial for optimizing management strategies.
Data Highlights
The study evaluated 171 patients with acute BPPV, identifying 47 patients (27.5%) as having refractory BPPV, defined as requiring three or more CRP attempts. Kaplan–Meier analysis indicated that cumulative resolution significantly increased during the first three CRP attempts but plateaued thereafter.
Key Findings
Refractory BPPV was defined as requiring three or more CRP attempts.
Lower serum 25-hydroxyvitamin D [25(OH)D] levels were independently associated with treatment resistance.
BPPV subtype and prior vestibular neuritis were the strongest predictors of treatment resistance.
Subgroup analysis revealed that lower 25(OH)D levels correlated with treatment resistance only in typical BPPV.
The inclusion of an interaction term between 25(OH)D and subtype showed a significant subtype-dependent effect.
Clinical Implications
Identifying patients at risk for refractory BPPV may help tailor treatment approaches.
Conclusion
Further research is warranted to explore the underlying mechanisms related to serum 25(OH)D levels and treatment resistance in BPPV.
