A Retrospective Comparison of Clinical Characteristics of Post-Traumatic and Idiopathic Benign Paroxysmal Positional Vertigo.

Objectives: This study aimed to assess the clinical and epidemiological characteristics of post-traumatic benign paroxysmal positional vertigo (BPPV) compared with idiopathic BPPV, with a focus on the impact of trauma severity on clinical outcomes.

Design: The authors conducted a retrospective analysis at a regional trauma center, comparing 66 patients with post-traumatic BPPV to 105 patients with idiopathic BPPV. Trauma was defined as cases where patients presented to the regional trauma center following an injury. The severity of trauma was categorized based on whether the trauma team was activated. The diagnostic criteria included positional vertigo and nystagmus, as confirmed through standard positional tests. Patients were categorized based on the severity of their trauma and evaluated for the BPPV subtype, frequency of canalith repositioning maneuvers (CRMs) needed for resolution, and recurrence rates.

Results: Patients with post-traumatic BPPV were younger than those with idiopathic BPPV (58.0 ± 15.2 versus 63.0 ± 13.1 yrs; p = 0.024) and showed no significant gender disparity. The most common BPPV subtype in the post-traumatic group was posterior canal BPPV (68.2%), followed by horizontal canal-BPPV (Geo) (22.7%), and horizontal canal-BPPV (Apo) (4.5%). Patients with post-traumatic BPPV required more CRMs for resolution compared with those with idiopathic BPPV (average: 2.0 versus 1.3; p = 0.001); however, the recurrence rates were similar between the two groups. Clinical presentations did not significantly differ between major and minor trauma cases.

Conclusions: Post-traumatic BPPV differed from idiopathic BPPV regarding age distribution, CRM frequency, and subtype proportions, but not regarding recurrence rates. Trauma severity did not significantly alter the clinical course of post-traumatic BPPV, suggesting a uniform approach to BPPV management irrespective of trauma severity. However, diagnosing BPPV after major trauma may be delayed; therefore, early consideration of BPPV in the initial stages of trauma assessment is necessary.