Probable Benign Paroxysmal Positional Vertigo Converts into Definite BPPV in One in Six Patients

OBJECTIVE: Patients with positional vertigo who have a positive Dix-Hallpike (DH) test are diagnosed as having definite benign paroxysmal positional vertigo (BPPV), and those who have a negative DH test as having probable BPPV. Little is known about the course of the disease in the latter group. The aim of the present study was to assess how many patients with probable BPPV convert into having a positive DH test during follow-up. MATERIALS AND METHODS: We included new patients who had experienced typical positional vertigo within the past 4 weeks and had a negative DH test. Patients were followed up over a period of 8 weeks. If the symptoms re-occurred, they were invited to return to the clinic for diagnostic DH test and, if positive, treated with a canalith repositioning maneuver. RESULTS: During the inclusion period of 18 months, 167 patients had probable BPPV, in which 43 fulfilled the inclusion criteria. The mean age of the patients was 57 (SD 14.5) years. Of the patients, 27 (63%) were females. During follow-up, 25 (58%) patients suffered from recurring positional vertigo, in which 13 underwent the DH test. Of the 13 patients, 8 were positive in 7 (16%) patients; 1 patient had a positive DH test twice. CONCLUSION: Among patients with a history of BPPV but a negative DH test at the first consultation, more than half (58%) experienced positional vertigo within 8 weeks. In 1 of 6 patients, the diagnosis was changed from probable to definite BPPV. Our advice to professionals who are confronted with a patient with symptoms of BPPV, but with a negative DH test, is to adopt a policy of low-threshold access for patients with recurring symptoms.