BPPV Prevalence

bppv Once again, more common than you think
This week I am posting two recent abstracts related to the prevalence of BPPV in both the young adult and geriatric population. I have long been a believer that there is much more BPPV out there than most physicians (and even many vestibular specialists) realize.

As far back as 15 years ago, I wrote an article about my suspicion that many patients with negative Dix-Hallpike exams had active BPPV that was fatigued out by the time they arrived in my office for examination. We did a simple experiment. We had them reschedule for the next day or two, and had them wear a neck collar from the minute they woke up, avoiding head movement until they were ready for re-examination. We found that 40% of patients with a previous negative Dix-Hallpike had a positive exam less than 48 hours later. That finding made me start thinking about the traditional diagnostic criteria for BPPV, which includes a positive Dix-Hallpike exam. More on that next week.

Until then, take a look at these two abstracts. The authors estimate that 11% of the geriatric population and 9% of the young adult population have BPPV at any given moment in time. Keep in mind, they are not talking about the percentage of people with dizziness complaints who have BPPV. They are discussing the population at large. A secondary finding of the geriatric BPPV study was that patients with undiagnosed BPPV also have a significantly higher rate of objective and subjective balance deficits and complaints.

Photo courtesy of https://www.med.unc.edu/ent/adunka/for-patients/symptoms-disorders/benign-paroxysmal-positional-vertigo-bppv

Here are the two abstracts:

Aging Clin Exp Res. 2012 Aug;24(4):317-23.
Benign paroxysmal positional vertigo is a common cause of dizziness and unsteadiness in a large population of 75-year-olds.
Kollén L1, Frändin K, Möller M, Fagevik Olsén M, Möller C.
1Department of Physiotherapy and Occupational Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden. lena.kollen@vgregion.se
BACKGROUND AND AIMS:
Studies have shown that 65% of people with dizziness may have a vestibular etiologic diagnosis, possibly benign paroxysmal positional vertigo (BPPV). The diagnosis of BPPV is based on medical history and findings after the Dix-Hallpike test. It is sometimes difficult to perform the Dix-Hallpike test in elderly persons, due to the limited range of motion when extending the neck. In this study, we used a side-lying test to stimulate the posterior semicircular canal, while the head and neck were fully supported on the examination table. The aims of this study were to investigate the prevalence of dizziness and/or impaired balance and BPPV in a population of 75-year-olds by means of a questionnaire and clinical tests, and to compare elderly persons with and without BPPV.
METHODS:
A representative population sample of 675 persons completed a questionnaire about dizziness and 571 persons underwent side-lying, static balance and dynamic walking tests.
RESULTS:
Subjective dizziness and/or impaired balance were found in 36% of subjects, especially when walking outdoors. A significant gender difference was found, with a higher prevalence in women (40%) compared with men (30%) (p<0.01). BPPV was found in 11% and was significantly more common in women (p<0.01). Elderly individuals with BPPV also displayed significantly impaired balance in static and dynamic balance tests compared with persons without BPPV (p<0.01). Persons with BPPV reported significantly more sub- jective problems with dizziness and balance compared with persons without BPPV (p<0.001).
CONCLUSIONS:
Subjective and objective unsteadiness, dizziness and BP- PV are common in the elderly
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PM R. 2013 Sep;5(9):778-85. doi: 10.1016/j.pmrj.2013.05.010. Epub 2013 May 22.
Prevalence of benign paroxysmal positional vertigo in the young adult population.
Kerrigan MA1, Costigan MF, Blatt KJ, Mathiason MA, Domroese ME
Department of Physical Therapy, Gundersen Health System, Mail Stop H03-014, Gundersen Health System, 1900 South Avenue, La Crosse, WI 54601
OBJECTIVE:
To evaluate the prevalence of benign paroxysmal positional vertigo (BPPV), defined as positionally induced nystagmus (PIN) with associated symptoms on provocative testing, in the young healthy adult population.
DESIGN:
A prospective, cohort, screening study.
SETTING:
A community-based hospital located in a small midwestern city with a greater metropolitan population of approximately 125,000.
PARTICIPANTS:
One hundred ninety-eight young adults (99 men and 99 women), ages 18-34 years and not being treated for dizziness or balance problems, were recruited from November 2009 to April 2010.
METHODS:
The participants completed questionnaires that detailed demographics, medical and surgical history, sports and/or activity participation history, and baseline symptoms commonly associated with BPPV. The participants were screened for inclusion with an ocular motor assessment in room light, followed by a vestibular positional assessment for BPPV with infrared camera-equipped goggles recorded on digital video disk.
MAIN OUTCOME MEASUREMENT:
The prevalence of BPPV, defined as PIN, along with symptoms in study participants.
RESULTS:
The prevalence of BPPV was 9% in this young adult population. Symptoms during testing were reported in 14% of all subjects (22% of women, 5% of men). Of 22 women who reported symptoms, 12 had PIN (P = .519), whereas the 5 men who reported symptoms all had PIN (P = .001). PIN, characteristic of that seen in BPPV (with or without associated symptoms), was identified in 53% of subjects, with 43% of subjects having posterior canal involvement, 10% having anterior canal involvement, and 8% having horizontal canal involvement. Eleven percent of subjects had bilateral semicircular canal involvement.
CONCLUSION:
Nine percent of our young adult subjects were diagnosed with previously unrecognized BPPV, with provoked symptoms of dizziness, headache, nausea, or imbalance, symptoms that may cause significant physical and psychosocial limitations if left untreated. This is an important finding because BPPV is an often-overlooked diagnosis that has a known, very effective treatment.
Copyright © 2013 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.