Analysis of factors affecting the efficacy of bilateral posterior semicircular canal occlusion in the treatment of refractory benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder. Refractory cases persist despite ≥3 repositioning maneuvers over 6 months. To identify factors influencing bilateral posterior semicircular canal occlusion (BPCO) efficacy in refractory BPPV. A retrospective study included 120 refractory BPPV patients undergoing BPCO. Patients were divided into Group A (successful outcomes, n = 84) and Group B (suboptimal outcomes, n = 36) based on postoperative DHI reduction (≥50% vs. <50%). Group B had a higher mean age (69.85 ± 4.15 vs. 62.28 ± 3.64 years, p =.012), longer disease duration (≥1 year: 30.56% vs. 10.73%, p < .01), and more bilateral BPPV (16.67% vs. 5.96%, p < .01). At 6 months, Group B showed poorer outcomes: higher dizziness handicap inventory (DHI) scores (53.24 ± 5.39 vs. 30.11 ± 2.88), lower SF-36 scores (58.10 ± 5.32 vs. 81.45 ± 6.29), higher recurrence rates (38.89% vs. 7.14%), and more frequent attacks (13.75 ± 3.66 vs. 4.36 ± 1.25/month) (p < .05). Multivariate analysis confirmed age, disease duration, and bilateral BPPV as independent risk factors (p < .01). Older age (≥65 years), prolonged disease duration (≥1 year), and bilateral BPPV predict poor BPCO outcomes in refractory BPPV. These factors are critical for preoperative decision-making.