Recurrent and Refractory Benign Paroxysmal Positional Vertigo: From the Unverified Maneuver to the Surgical Indication. A Narrative Review

This is the authors' abstract. We don't add key points for this paper.

Article type: Review article Introduction: benign paroxysmal positional vertigo resolves with repositioning maneuvers in more than 90 % of cases, yet a fraction persists and eventually raises the question of surgical treatment through semicircular canal occlusion. Both strategies have been evaluated separately, and the criterion for considering a patient refractory varies across the available studies. Methods: narrative review based on a search of PubMed/MEDLINE, Web of Science, Scopus, and SciELO, using MeSH descriptors and free-text terms, in English, Spanish, and Portuguese. The synthesis focused on current guidelines, systematic reviews, randomized trials, and the surgical series published since the original description of the technique. Results: the declared threshold for surgical indication ranges from two failed maneuvers to twelve months of persistence, without the reviewed studies justifying it. Maneuvers achieve 80 % to 95 % in the first line, but only 27 % to 39 % in patients who have already failed. That ceiling is inflated: two out of three patients referred for suspected disease do not have it, and one in seven retains nystagmus after treatment when the result is not recorded. Canal occlusion reports 100 % resolution, yet only three of eight studies measured the diagnostic test before and after, and the procedure carries an 8 % rate of permanent sensorineural hearing loss. Conclusion: the surgical decision in refractory positional vertigo should rest not on the number of failed maneuvers or elapsed time, but on objective verification that the disease was present and that treatment was correctly performed.