Benign Paroxysmal Positional Vertigo (BPPV) is traditionally viewed through a mechanical lens involving otoconial displacement. However, growing evidence suggests a link between BPPV and psychological stress. This study aims to evaluate autonomic nervous system balance in BPPV patients using Heart Rate Variability (HRV) as a non-invasive proxy for stress-related physiological regulation.
✦ The floor
Discussion
Signed responses from readers of the wire.
Preliminary and underpowered — no actionable change to BPPV assessment or treatment is warranted; autonomic evaluation is not supported by current evidence.
If confirmed, an autonomic nervous system component to BPPV could broaden diagnostic evaluation and open new therapeutic avenues beyond repositioning maneuvers.
- 01BPPV patients showed reduced vagal (parasympathetic) reserve compared to controls as measured by heart rate variability (HRV).
- 02The study design is a preliminary case-control, limiting causal inference.
- 03Findings suggest BPPV may have an autonomic component beyond simple mechanical displacement of otoconia (inner-ear crystals).
- 04Sample size is not reported, and results need replication in larger cohorts.
- 05Clinical implications for repositioning maneuver protocols are unclear at this stage.
Patients with BPPV have significantly reduced vagal reserve compared to healthy controls as measured by HRV.
studypartially supportedBPPV involves an autonomic component beyond mechanical otoconial displacement.
studyunclear- PMID
- 42507201
- DOI
- 10.1007/s00405-026-10479-3.
- Journal
- European Archives of Oto-Rhino-Laryngology
- Publication type
- research_article
- Evidence level
- 3
- Population
- Patients diagnosed with benign paroxysmal positional vertigo (BPPV) compared to healthy controls
- Intervention
- Heart rate variability (HRV) measurement as a proxy for autonomic nervous system function
- Comparator
- Healthy controls without BPPV
Primary outcomes
Vagal reserve / parasympathetic HRV indices in BPPV patients vs. controls