Evaluation of Anxiety and Dizziness Handicap in First and Recurrent Benign Paroxysmal Positional Vertigo Patients: A Prospective Observational Study

Benign paroxysmal positional vertigo (BPPV) is the most frequent peripheral vestibular disorder causing episodic vertigo. Although canalith repositioning manoeuvre (CRM) are highly effective, recurrent episodes are often associated with persistent dizziness and anxiety. This study aimed to compare dizziness handicap and anxiety levels between first-episode (FE) and recurrent-episode (RE) BPPV patients following CRM. A prospective observational study was conducted in the Department of ENT, Government Medical College, Jammu, over eighteen months. A total of 89 patients were enrolled, including 38 with FE BPPV and 51 with RE BPPV. The Dizziness Handicap Inventory (DHI) and State–Trait Anxiety Inventory (STAI) were administered before treatment, after the first session, and at a second follow-up. Statistical analysis was performed to evaluate within-group and between-group differences (p < 0.05 considered significant). A total of 89 patients were included, comprising 38 with first-episode (FE) and 51 with recurrent-episode (RE) BPPV. Baseline demographic and clinical characteristics were comparable between the groups. Posterior canal involvement was the most common in both groups, with no significant difference in canal distribution (p = 0.784). Baseline median Dizziness Handicap Inventory (DHI) scores were similar between FE and RE patients (43.4 vs. 40.5; p = 0.253). Following canalith repositioning manoeuvres (CRM), DHI scores improved in both groups, with no significant between-group difference at the second session (22 vs. 20; p = 0.332). State anxiety scores were comparable at baseline (47 vs. 50; p = 0.194) and showed a significant reduction after treatment in both groups (p < 0.001), with no difference immediately post-treatment (p = 0.722). However, at the second session, state anxiety was significantly higher in the RE group (39 vs. 28; p < 0.001). Trait anxiety was significantly higher in RE patients at baseline (40 vs. 34; p < 0.001) and remained elevated across all time points despite treatment. Within-group improvement in trait anxiety was observed in the FE group (p = 0.014 and p = 0.002), but not in the RE group (p = 0.092 and p = 0.872). CRM resulted in significant improvement in dizziness and state anxiety across all patients. However, recurrent BPPV cases exhibited persistently higher trait anxiety, suggesting an underlying psychological predisposition influencing recurrence and recovery.