Material and Method: The medical records of BPPV patients with positive testing result on the Dix-Hallpike or supine roll test between January 2002 and December 2012 at Songklanagarind hospital, Thailand were retrospectively reviewed.

Results: Of the 951 BPPV patients, 595 patients were in the younger group (age ≤60-year-old, mean age = 46.9±8.9 years) and 356 patients were in the elderly group (age >60-year-old, mean age = 69.3±6.7 years). The most common etiology of BPPV was idiopathic. No significant difference was found regarding gender and semicircular canals that were involved in both groups. The most involved semicircular canal was the posterior canal. The most common described symptom of BPPV was vertigo. Patients in the elderly group were less likely to describe vertigo as the presenting symptom of BPPV compared to those in the younger group (OR = 0.22; 95% CI, 0.12-0.41; p<0.001). The elderly group usually complained of imbalance and dizziness (OR = 15.83; 95% CI, 8.7-28.8; p<0.001 and OR = 10.12; 95% CI, 5.23-19.59; p<0.001, respectively). The duration of the symptom before diagnosis was longer in the elderly, when compared to the younger group (30 days, median; IQR = 7, 61 versus 5 days, median; IQR = 2, 7), respectively (p<0.001). The ability to describe the trigger event precisely was less in the elderly group (63.8% versus 82.2%, p<0.001). The elderly group significantly underwent brain imaging studies more than the younger group (8.4% versus 3.5%, p = 0.02). Outcome of the treatment after the repositioning procedure was comparable in both groups (p = 0.58). Approximately 80% of patients in both groups had complete recovery from BPPV during their last visit.

Conclusion: Dizziness and imbalance were the common presenting symptoms of BPPV in the elderly. The younger patients tended to describe the classic symptom of vertigo that was specific to BPPV more precisely than the elderly. These may contribute to underestimate BPPV, do unnecessary brain imaging study, and take more time to get the correct diagnosis of BPPV among elderly patients.

Keywords: Benign paroxysmal positional vertigo, BPPV, Elderly, Vertigo, Dizziness