Further Outpatient Care
See the list below:
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Close follow-up is essential for treatment of patients with posttraumatic vertigo.
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Vestibular rehabilitation can help patients to cope with vertigo.
Complications
Treatment failures are most likely secondary to misdiagnosis. Posttraumatic vertigo can be treated successfully once the underlying cause is identified. The causes can be identified in most cases using the appropriate history, physical examination, and neurotological tests.
Prognosis
The prognosis depends on the diagnosis and the response to conservative therapy. A literature review by Aron et al suggested that symptom resolution rates in posttraumatic BPPV are comparable to those in nontraumatic BPPV. The investigators added, however, that multicanal involvement may be more prevalent in posttraumatic BPPV, leading to the need for more repositioning maneuvers in these patients than in those with the nontraumatic variety. They also stated that more studies are needed to prove their assertions, owing to a current lack of well-designed studies with adequate cohorts. [17]
Similarly, a literature review by Chen et al also indicated that resolution of traumatic BPPV requires more repositioning maneuvers than does idiopathic BPPV (relative risk [RR] = 3.27). Moreover, traumatic BPPV was found to have a higher recurrence rate than the idiopathic form (RR = 2.91). [18]
A study by Prokopakis et al suggested that canalith repositioning procedures (CRPs) have less long-term efficacy in patients with BPPV who have suffered head trauma than in other patients with the condition. The study involved 965 patients, who were followed up at 48 hours and 7 days following their initial treatment and then every 6 months, for a mean total of 74 months. They were treated with variants of either the Epley maneuver or the barbecue roll maneuver, depending on whether they had posterior and anterior canal involvement or horizontal canal involvement, respectively. The investigators found that symptoms of benign paroxysmal positional vertigo recurred in 139 patients, with the recurrence rate being significantly greater in patients with head trauma, as well as in elderly patients and in those with a history of vestibular neuropathy. [19]
On the other hand, a retrospective study by Luryi et al did not find a traumatic etiology for BPPV to be linked to a greater risk for the condition’s recurrence. [20]
A Korean study, by Kim et al, indicated that greater severity of trauma and a longer stay in the intensive care unit (ICU) delay management of traumatic BPPV, finding that in the report’s patients, implementation of CRPs for BPPV took place after 10 days in patients with major trauma, versus 3 days in those with minor trauma. The investigators recommended, however, that CRPs be employed early, with spontaneous resolution of BPPV possibly being less likely in severely injured patients due to immobilization and the prompt employment of CRPs being an important factor in the management of BPPV. [3]
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Posttraumatic vertigo. The Dix-Hallpike maneuver.
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Posttraumatic vertigo. The Epley maneuver.
