Clinical features and treatment of multi-canal benign paroxysmal positional vertigo

OBJECTIVE: To reveal clinical features of natural history, diagnosis and treatment of multi-canal benign paroxysmal positional vertigo (m-BPPV). PATIENTS AND METHODS: 640 patients with BPPV are evaluated. 80 (12.5%) patients had m-BPPV, 560 (87.5%) patients had single-canal BPPV. The analyses of involved canals and comparison of the course of the disease and effectiveness of treatment in m-BPPV and single-canal BPPV was done. RESULTS: m-BPPV accounts for 12.5% of all patients with BPPV. In m-BPPV mostly unilateral involvement of posterior and horizontal canals are involved, in bilateral BPPV often both posterior canals are involved. M-BPPV is more often associated with middle and inner ear diseases. Recurrences are more often observed in m-BPPV. For m-BPPV it is typical to have more severe clinical symptoms: constant dizziness, balance problems, intensive nausea and vomiting, frequent falls. M-BPPV is often resistant to treatment with repositioning maneuvers: more maneuvers, more follow-up consultations, carrying out home-based vestibular exercises by patients and use of mechanical chair in some cases are necessary to achieve successful treatment. In patients with m-BPPV residual dizziness after successful treatment often takes place, so that additional diagnosis and assessment is needed.