Treatment Outcomes of Multiple Canal vs Single Canal Benign Paroxysmal Positional Vertigo (BPPV); A Prospective Comparative Study

Abstract

Background: Multiple canal BPPV is a less explored entity and studies regarding the same is very less. In this study we are exploring the treatment responses of multiple canal BPPV compared to single canal BPPV. This is a prospective comparative study where patients with BPPV is evaluated in a teritiary care centre in Calicut, Kerala
Aims and Objectives:
• To find response for canalolith repositioning manoeuvre in Multiple canal BPPV in comparison with Single canal BPPV
• To compare the number of treatment sessions in Multiple canal BPPV & Single canal BPPV
Methods: 50 patients with single canal BPPV and 50 patients with multiple canal BPPV were evaluated in our centre by position test from April 2023 to September 2023. Dix Hallpike test for posterior semicircular canal, roll over test for lateral semicircular canal and head hanging test for anterior semicircular canal was done . In patients with multiple canal BPPV most affected canal was identified and repositioning manoeuvre was done to the most affected side . Epley’s manoeuvre was done for posterior semicircular canal, Log roll manoeuvre done for lateral semicircular canal & Yacouvino manoeuvre for anterior semicircular canal .In patients with single canal BPPV affected canal was identified and repositioning manoeuvre was done . Patients were asked to review in ENT OPD every 2 days to look for symptom resolution. If symptomatic, position test was repeated. Patient had to review till symptoms resolved.
Results and Analysis: Age of participants were between 20 to 81 years, with a mean age of 54.3 years. There was no significant difference in sex distribution of two groups. History of trauma was more frequent in patients with Multiple Canal BPPV as compared to Single canal BPPV. Half of those with Multiple Canal BPPV had at least one comorbidity as compared to 26% of those with Single Canal BPPV. It was found that in multiple canal BPPV the most common combination of canals was ipsilateral PSCC and LSCC (40%), followed by bilateral PSCC (32%). In single canal BPPV, Posterior semicircular canal was most commonly affected followed by horizontal canal. No patients had anterior canal BPPV. Nearly half of (46.0%) those with Single Canal BPPV has symptom resolved by the first visit. About 60% of those with Multiple canal BPPV had symptom resolution by second visit. Overall, by the second visit, 96% of those with Single Canal BPPV had resolution of symptoms, whereas in case of Multiple Canal BPPV, this was 60%.In our study also patients with multiple canal BPPV had response to repositioning manoeuvres, but they needed a slightly longer treatment course compared to single canal BPPV.
Conclusion: Treatment response of multiple canal BPPV is comparable to single canal BPPV. But patients are required to have frequent follow ups to identify the most affected canal and to do the repositioning manoeuvres to most affected canal. Most of the patients with multiple canal BPPV required 2 or more visits for symptom resolution. But majority of patients with single canal BPPV had symptom resolution by second visit. Patients with comorbidities (e.g.: Diabetes Mellitus, Hypertension, CAD) are more prone to multiple canal BPPV.