Vol.:(0123456789) 1 3 Journal of Neurology https://doi.org/10.1007/s00415-019-09502-x REVIEW Benign paroxysmal positional vertigo in Meniere’s disease: systematic review and meta‑analysis of frequency and clinical characteristics Mansur A. Kutlubaev 1,2  · Ying Xu 3,4  · Jeremy Hornibrook 5 Received: 16 July 2019 / Revised: 5 August 2019 / Accepted: 7 August 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract There is a recognized association of Meniere’s disease (MD) and benign paroxysmal positional vertigo (BPPV). However, the frequency and clinical characteristics of BPPV in MD are unclear. The aim of this review was to determine the mean frequency and clinical features of BPPV in MD. Three databases were searched: MEDLINE, PubMed and Google Academia. Studies reporting the frequency of BPPV in MD were pooled. A total of 4198 references were identifed, of which 20 studies were considered eligible. The pooled frequency of BPPV in MD was 14% (95% CI 9–18%). It was 38% (95% CI 26–49%) in longitudinal studies and 8% (95% CI 6–11%) in cross-sectional ones. BPPV comorbid with MD was mostly observed in the ear afected by hydrops, in females, in patients with more advanced disease. Canalolithiasis of the horizontal semicircular canal was more common in patients with BPPV associated with MD than in idiopathic BPPV. BPPV in MD was more prone to recurrence and required more canal repositioning maneuvers. Keywords Benign paroxysmal positional vertigo · Meniere’s disease · Hydrops · Otolithiasis · Vertigo Introduction Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo in clinical practice. It develops because of degeneration of the utricular neuroepithelium leading to the detachment of otoconia, which freely foat in semicircular canals (SCCs), or attach to the cupula, mak- ing the labyrinth sensitive to gravitational forces [1]. Most BPPV cases are idiopathic; however, some are secondary. The latter develop in inner ear diseases, after vestibular neu- ritis or head trauma [1, 2]. Meniere’s disease (MD) is a chronic progressive multi- factorial condition presenting with recurrent vertigo attacks, fuctuating hearing loss, tinnitus and aural fullness [3]. The basic pathophysiological feature of MD is excessive endo- lymph in the endolymphatic space, called endolymphatic hydrops. The cause of the hydrops is unknown. The main theories are a viral infection, autoimmune involvement of the sac, a genetically determined abnormality of endolymph control, and variations in the size and position of the sac and endolymphatic duct [4]. According to Schuknecht’s histopathological studies [5], vertiginous attacks in MD develop as a result of the rupture of Reissner’s membrane and potassium intoxication of the perilymph. Contemporary studies do not support this theory [6]. The drainage theory by Gibson and Arenberg attempts to explain the attacks by a dysfunctional or blocked endolym- phatic sac, which impairs longitudinal fow of endolymph, leading to its buildup in the sinus of the endolymphatic duct. Excessive endolymph refuxes through the utricular valve of Bast and into the ampullae of the semicircular canals and results in the attack of vertigo [6]. * Mansur A. Kutlubaev Mansur.Kutlubaev@yahoo.com 1 Department of Neurology, Bashkir State Medical University, Ufa, Russia 2 Department of Neurology, G.G. Kuvatov Republican Clinical Hospital, Ufa, Russia 3 Sydney Medical School, University of Sydney, Sydney, NSW, Australia 4 The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Camperdown, NSW, Australia 5 Department of Otolaryngology-Head and Neck Surgery and Audiology, Christchurch Hospital, Riccarton Avenue, Christchurch, New Zealand