Early management for traumatic benign paroxysmal positional vertigo in traumatically injured patients

Abstract

OBJECTIVES: The purpose of this study was to identify the clinical features of posttraumatic benign paroxysmal positional vertigo (t-BPPV) in traumatically injured patients, investigating the effectiveness of the early diagnosis and management including canalith repositioning procedures (CRPs). PATIENTS AND METHODS: The subjects of the present study were 74 patients who were hospitalized in the Trauma Center, Ajou University Hospital. We investigated the relationship between injury mechanisms and t-BPPV. Patients with t-BPPV were categorized into mild (typical BPPV) and severe (bilateral, recurrent, or persistent) types. RESULTS: Of the 74 patients, 41 were diagnosed with t-BPPV. Nineteen were mild and 22 were severe types. 'A fall' (36%) and 'pedestrian car accident' (32%) were common as the injury mechanisms provoking severe t-BPPV. In the severe t-BPPV group, they were hospitalized longer (as median value, 20 days in the severe group vs. 10 days in the mild group, P = 0.004), stayed longer in intensive care unit (3 days vs. 0 days, P = 0.016), and needed more days until the BPPV management (13.5 days vs. 6 days, P = 0.021). Major trauma (the Injury Severity Score >15) patients had a longer time to implementation of the first CRPs (10 days in major trauma and 3 days in minor trauma patients, P = 0.019). CONCLUSIONS: Severity of trauma and longer duration of ICU treatment were factors delaying BPPV management. This delay could negatively affect the progress of t-BPPV. Diagnostic and therapeutic maneuvers including CRPs should be performed as early as possible, even in severely injured patients.