Clinical Evaluation of Benign Paroxysmal Positional Vertigo in Patients after Mild to Moderate Head Trauma

Abstract

Background:

Benign paroxysmal positional vertigo (BPPV) is a common sequelae of head trauma, yet its incidence, clinical profile, and response to treatment remain underreported in patients with mild to moderate head injury. This study aimed to evaluate the clinical characteristics and treatment outcomes of BPPV in such patients.

Materials and Methods:

A prospective observational study was conducted in a tertiary care hospital. A total of 120 patients aged 18–65 years with mild to moderate head trauma and subsequent vertiginous symptoms were evaluated. Clinical assessment included Dix-Hallpike and supine roll tests to confirm BPPV and determine canal involvement. Patients underwent appropriate canalith repositioning maneuvers and were followed up at 1 week, 1 month, and 3 months.

Results:

Of 120 patients (mean age 41.8 years; 61.7% male), road traffic accidents accounted for 56.7% of injuries. BPPV was diagnosed in 22 cases (18.3%). The posterior semicircular canal was most frequently involved (68.2%), followed by horizontal (27.3%) and anterior canals (4.5%). BPPV was more frequent in patients with road traffic accidents (20.6%) compared to falls (18.8%) or domestic slips (10.0%), though the difference was not significant (P = 0.31). Following repositioning maneuvers, complete relief was achieved in 72.7% at 1 week, 90.9% at 1 month, and 100% at 3 months, with no recurrences observed.

Conclusion:

Nearly one-fifth of patients with mild to moderate head trauma developed BPPV, predominantly affecting the posterior canal. Canalith repositioning maneuvers were highly effective, ensuring complete recovery without recurrence.

INTRODUCTION

Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder, characterized by brief episodes of vertigo triggered by head movements due to displaced otoconia, most often in the posterior semicircular canal.[1] Diagnosis is based on positional maneuvers such as the Dix–Hallpike and supine roll tests, while canalith repositioning maneuvers (CRMs) remain highly effective treatment options.[1,2,3] Head trauma is a recognized risk factor for BPPV. Prospective data indicate an incidence of about 7% within three months of mild head injury,[4] and population-based studies confirm increased BPPV risk following head trauma, proportional to injury severity.[5] Post-traumatic BPPV (PT-BPPV) may involve bilateral or multicanal disease and often requires repeated maneuvers compared to idiopathic cases.[6,7] Given the frequency of mild to moderate head injuries, recognizing PT-BPPV is important for timely intervention and improved recovery. This study was undertaken to evaluate the clinical profile, canal involvement, and treatment outcomes of BPPV following mild to moderate head trauma.

MATERIAL AND METHODS

This prospective observational study was conducted in a tertiary care hospital. A total of 120 patients aged 18–65 years with mild to moderate head trauma (GCS 9–15) who developed vertigo within 2 weeks of injury were enrolled. Patients with severe head injury, pre-existing vestibular disorders, neurological deficits, or inner ear disease were excluded.

Detailed history, clinical examination, and vestibular tests (Dix-Hallpike and supine roll tests) were performed in all cases. The type of canal involvement, nystagmus characteristics, and associated findings were documented. Patients diagnosed with BPPV underwent appropriate canalith repositioning maneuvers (Epley for posterior canal, Barbecue for horizontal canal). Outcomes were assessed at 1 week, 1 month, and 3 months. Data were analyzed using SPSS v25, with the Chi-square test applied for categorical variables; P < 0.05 was considered significant.

RESULTS

Out of 120 patients with mild to moderate head trauma, the mean age was 41.8 ± 12.6 years, with most cases in the 31- to 45-year group (33.3%). Males predominated (61.7%), and road traffic accidents were the leading cause of injury (56.7%) [Table 1].

Table 1.

Demographic characteristics of the study population (n=120)

Variable		Category		n		%
Age (years)		18–30		28		23.3
		31–45		40		33.3
		46–60		36		30.0
		>60		16		13.4
Sex		Male		74		61.7
		Female		46		38.3
Mode of trauma		Road traffic accident		68		56.7
		Fall from height		32		26.6
		Domestic fall/slip		20		16.7

BPPV was diagnosed in 22 patients (18.3%) [Figure 1]. The posterior semicircular canal was most frequently affected (68.2%), followed by horizontal (27.3%) and anterior canals (4.5%) [Figure 2]. Although BPPV occurred more often after road traffic accidents (20.6%), the association between trauma type and BPPV was not statistically significant (P = 0.31) [Table 2].

Figure 1.

Incidence of BPPV following mild to moderate head trauma

Figure 2.

Type of semicircular canal involvement in BPPV

Table 2.

Association of mode of trauma with BPPV occurrence

Mode of trauma		Total cases		BPPV (n)		%		P
Road traffic accident		68		14		20.6		0.31
Fall from height		32		6		18.8
Domestic fall/slip		20		2		10.0
Total		120		22		18.3

Following canalith repositioning maneuvers, 72.7% achieved complete symptom relief within one week, rising to 90.9% at one month. At 3 months, all patients were symptom-free with no recurrences [Table 3].

Table 3.

Treatment outcome following canalith repositioning maneuvers (n=22)

Outcome at follow-up		1 Week (n, %)		1 Month (n, %)		3 Months (n, %)
Complete symptom relief		16 (72.7%)		20 (90.9%)		22 (100%)
Partial relief		6 (27.3%)		2 (9.1%)		0 (0%)
Recurrence		0 (0%)		0 (0%)		0 (0%)

DISCUSSION

In this study, BPPV was observed in 18.3% of patients with mild to moderate head trauma, consistent with previous reports of post-traumatic BPPV incidence ranging from 7% to 28%.[4,7] This highlights that even mild head injuries can result in clinically significant vestibular dysfunction.

The posterior semicircular canal was most commonly involved, aligning with prior studies showing its susceptibility to otolith displacement following trauma.[8,9] In contrast to some literature suggesting a higher risk of BPPV after road traffic accidents, our analysis did not find a statistically significant association between trauma type and BPPV occurrence.[10]

Canalith repositioning maneuvers were highly effective, with complete symptom resolution in all patients by 3 months. Other studies similarly report high short-term success of CRMs, although recurrence rates of 13–50% have been noted.[11,12] Factors contributing to recurrence may include residual canalith debris, multicanal involvement, or coexisting vestibular disorders.[13]

We did not assess psychological comorbidities, which may influence symptom severity and recurrence. Future studies should explore these factors to optimize management strategies.

CONCLUSION

Benign paroxysmal positional vertigo was identified in nearly one-fifth of patients following mild to moderate head trauma, with the posterior semicircular canal being most frequently involved. Although more common after road traffic accidents, the type of trauma was not significantly associated with BPPV occurrence. Canalith repositioning maneuvers were highly effective, with all patients achieving complete symptom resolution and no recurrences during follow-up. Early recognition and prompt treatment can ensure excellent outcomes in post-traumatic BPPV.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.