Int. Adv. Otol. 2009; 5(3); 377-382

Idiopathic Benign Paroxysmal Positional Vertigo (BPPV):  Recurrent versus alternating relapses.
Giovanni Ralli, Francesca Atturo, Sara Cisternino, Annarita Vestri

Department of Otorhinolaryngology, Audiology and Phoniatrics “G. Ferreri”, University of Rome “La Sapienza”, gralli@libero.it

Objective: Although relapse of BPPV is frequent, its basic characteristics have not been defined yet. In this study we enrolled
patients with idiopathic BPPV that had never previously suffered from vertigo and observed them from the onset of disease.

Material and Methods: We studied 61 patients and included them in a follow up period comprised between 24 and 108 months
to identify relapses. We studied the side of relapse and divided patients into a group that relapsed in the same side of the first
episode (recurrent BPPV) and another that relapsed in the contralateral ear (alternating BPPV). Separately we studied patients
with simultaneous bilateral BPPV. The Kaplan-Meyer method was applied as a predictor of relapses.

Results: During the follow up period, we observed a relapse in 23 patients (37%). In 9 patients (39,1%) relapse occurred in
the same side of the first attack, in 12 patients (52,2%) in the contralateral labyrinth, and in 2 (8,7%) there was a simultaneous
involvement of both sides. Using the Kaplan-Meyer method, we identified a relapse in 73% of recurrent BPPV and only in 25%
of alternating BPPV patients in a 12-month period (log-rank p=0.009).

Conclusion: The differences found in the recurrence characteristics between patients with a recurrent BPPV compared to
those with alternating BPPV supports the classification proposed.