Study on Comorbidities in Benign paroxysmal positional vertigo and its role in recurrence

Benign Paroxysmal Positional Vertigo (BPPV) is one of the common conditions of the peripheral vestibular system which presents to the otorhinolaryngology department. It accounts for 20 to 30 % of otologic causes of vertigo with a life time prevalence of 2.4% Recently studies have found that BPPV is associated with systemic disorders like hypertension, diabetes mellitus, thyroid disorders, hyperlipidemia, Vitamin D deficiency and may be responsible for increased frequency of recurrence BPPV following treatment, reducing the quality of life. Thus if there is any relation of recurrence BPPV associated with comorbidities exists the treatment of comorbidities may reduce the frequency of recurrence. The study aim is to find the relation of recurrence/residual disease in BPPV patients with comorbidities. The patients are diagnosed as BPPV with history of giddiness and confirmed by neuro otological examination by positional tests with video nystagmography are included in the study and the associated comorbidities like diabetes mellitus, hypertension, coronary artery disease, hypothyroidism, tuberculosis, malaria etc. are noted. The positional test performed were Dix-Hallipike maneuver, Mc Clure- Pagnini test, deep head hanging is done to find the canal affected. The treatment initiated are Yacovino’s manoeuver for anterior canal BPPV, Epleys for posterior canal BPPV, 360-degree barbeque maneuver for lateral canal BPPV. After one week, the positional tests were performed to confirm whether the particular canal BPPV was resolved or not. If the BPPV is not resolved the number of times the corrective manoeuver and the relation to the comorbidity is analyzed. The follow up period were ranging from six months to five years. In our study we conclude that comorbidities do not play a significant predisposing factor or recurrence. The recurrence or residual disease can be attributed due to improper diagnosis or maneuver techniques, which can be avoided by making proper diagnosis with video nystagmography, identify the correct canal affected by positional tests and perform the correct maneuvers to resolve the BPPV. In the 6 cases of persistence of symptoms after a brief interval free period, can be attributed to improper positioning of patients in the maneuver, where 5 got resolved of symptoms but 1 patient of cupulolithiasis patient with persistent even in the second week may be due to the adherent otoconia which would have dislodged in due course of the corrective maneuvers.