Residual dizziness after successful repositioning maneuvers for idiopathic benign paroxysmal positional vertigo in the elderly

Even after successful repositioning maneuvers for benign paroxysmal positional vertigo (BPPV), some patients report dizziness lasting for a certain period afterwards. We studied the prevalence and clinical factors associated with residual dizziness in a sample of elderly patients. Sixty outpatients over 65 years of age, affected by idiopathic BPPV were recruited; the exclusion criterion was a history of previous episodes of vertigo, including positional. The patients were asked to describe their self-perceived anxiety for vertigo on a Visual Analogue Scale (VAS) and successively treated with appropriate maneuvers till resolution of nystagmus. Data concerning the demographic and clinical features of BPPV were collected. Patients were followed until complete resolution of subjective dizziness and imbalance without positional nystagmus. Data about residual dizziness were collected from the second day from resolution of BPPV. Clinical and demographic factors related to residual dizziness were analyzed. Twenty-two subjects (37%) reported residual dizziness. In these subjects, the mean duration of residual dizziness was 13.4 ± 7.5 days. No association was observed between residual dizziness and gender, involved canal and the number of repositioning maneuvers before resolution. On the other hand, age older than 72 years, symptom duration greater than 9 days and VAS scale for anxiety greater than 10/100 were associated with an increased risk of residual dizziness. The odds ratio were respectively 6.5 (age—residual dizziness, Confidence Interval 95%), 6.5 (duration of vertigo—residual dizziness, Confidence Interval 95%) and 15.5 (anxiety levels—residual dizziness, Confidence Interval 95%). Longer symptom duration before diagnosis was associated with higher anxiety levels. The results underline the necessity for an early and correct diagnosis of BPPV, especially in the elderly.