Complications
An episode of BPPV is expected to occur in a large proportion of patients during the procedure, due to canalith movement in the semicircular canal.
A sudden head movement while driving or riding a motorcycle (e.g., checking the blind spot) can precipitate an episode of BPPV and result in a collision.
Physicians should inquire about a patient's occupation and driving status and advise the patient appropriately. Treatment with a repositioning manoeuvre should be carried out as soon as possible.
An episode of BPPV can result in serious accidents in any number of circumstances relating to work or leisure activities. Physicians should take particular care to inquire about activities involving heights, diving, or operating heavy machinery. Treatment with a repositioning manoeuvre should be carried out as soon as possible.
During repositioning manoeuvres, canaliths may become displaced from one canal and enter another. Affected patients then need to be treated with the appropriate manoeuvres for these variants, or referred to a dizziness clinic. Fortunately, the lateral canal variant has a much higher spontaneous recovery rate relative to posterior canal BPPV.
An episode of BPPV is expected to occur during a repositioning manoeuvre, and this can result in nausea, emesis, or imbalance.
These patients may require antiemetic treatment prior to initiating a subsequent repositioning manoeuvre. An antiemetic given 30 to 60 minutes prior to a repositioning manoeuvre can provide effective prophylaxis.
A small sub-population of patients with prolonged autonomic dysfunction and imbalance may benefit from vestibular suppressant medication post-repositioning manoeuvre therapy.
Almost 10% of older patients experience BPPV.[5] Older patients often can have co-existing proprioceptive, visual, and vestibular dysfunction, as well as decreased muscle strength, arthritis, and osteoporosis.
Physicians should discuss the use of walking sticks, walkers, and railings, and treat the patient with a repositioning manoeuvre as soon as possible.
Less than 5% of patients may experience some degree of permanent hearing loss following posterior semicircular canal occlusion surgery, most probably from an inflammatory labyrinthitis.[99]
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