Clinical features and outcome predictors in benign paroxysmal positional vertigo and its variant: Perspective in a primary care neurology clinic

Background and Purpose Previous studies on benign paroxysmal positional vertigo (BPPV) have primarily been performed in referral-based clinics. This study aimed to explore the clinical characteristics of BPPV and its variant (light cupula) in a primary care setting. Methods We retrospectively analyzed the clinical data of 1126 patients who visited a primary care neurology clinic due to dizziness or vertigo between March 2023 and February 2024. We collected information on age, sex, affected ear, symptom duration at the first evaluation, BPPV subtypes (including the variant), duration of positional nystagmus (transient: <1 min vs persistent: ≥1 min), and the number of canalith repositioning procedures (CRPs) required for treatment. Results A total of 308 patients (27.4%) were diagnosed with BPPV or its variant. Subtypes included posterior canal (PC) type in 183 (59.4%), geotropic horizontal canal (HC) type in 73 (23.7%), apogeotropic HC type in 43 (14.0%), anterior canal type in 4 (1.3%), and mixed type in 5 (1.6%). The proportion of PC type increased with a longer duration of symptoms ( p = 0.012). In multinomial regression, only the duration of positional nystagmus was significantly associated with the number of CRPs ( p < 0.001), as patients with persistent nystagmus required more CRPs than those with transient nystagmus. Conclusions In primary care, the proportion of each subtype of BPPV and its variant differs according to symptom duration. Furthermore, patients with positional nystagmus lasting more than 1 minute tend to be more refractory to CRPs.