Mareo residual asociado al vértigo posicional paroxístico benigno: reconocimiento, factores de riesgo, epidemiología colombiana y estrategias de seguimiento basadas en evidencia
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Abstract
El vértigo posicional paroxístico benigno (VPPB) representa la vestibulopatía periférica más frecuente en la práctica clínica contemporánea y constituye una de las principales causas de consulta por vértigo y mareo en servicios de otorrinolaringología, neurología, geriatría, medicina interna y rehabilitación (1,2). A pesar de que las maniobras de reposicionamiento canalicular han transformado el abordaje terapéutico del VPPB y permiten resolver exitosamente el vértigo rotatorio y el nistagmo posicional en la mayoría de los pacientes, la experiencia clínica acumulada durante las últimas décadas ha demostrado que una proporción considerable de individuos presenta recurrencia de los episodios o síntomas persistentes de inestabilidad tras la aparente resolución del episodio vestibular agudo (1,2). Estos síntomas incluyen sensación de flote, inestabilidad, intolerancia al movimiento, sensación de “cabeza pesada” y mareo inespecífico aun en ausencia de nistagmo posicional objetivo (3). Históricamente, estos cuadros fueron frecuentemente considerados fenómenos transitorios menores o atribuidos principalmente a ansiedad y somatización. Sin embargo, la creciente evidencia científica ha permitido reconocer que el denominado mareo residual asociado al VPPB (en inglés, BPPV-related residual dizziness) constituye una entidad clínica compleja, multifactorial y probablemente subdiagnosticada, con implicaciones significativas sobre funcionalidad, calidad de vida, autonomía y riesgo de caídas (3).
En este contexto, la reciente publicación del artículo “Enhancing patient care in BPPV-related residual dizziness: introducing the CLEAR algorithm to support BPPV-RD recognition and follow-up strategies” representa una contribución importante hacia la construcción de modelos más integrales de atención vestibular (3). El algoritmo CLEAR (Clinician-Led Evaluation for Assessment of Residual dizziness) propone una aproximación estructurada para el reconocimiento, clasificación, estratificación de riesgo y seguimiento clínico del mareo residual asociado al VPPB, integrando mecanismos periféricos y centrales, factores metabólicos, aspectos funcionales y estrategias terapéuticas dirigidas no solamente a la resolución del nistagmo, sino también a la recuperación funcional integral del paciente (3).
Desde Colombia, y mediante una visión interdisciplinaria construida entre especialistas en otorrinolaringología, otología, otoneurología/medicina vestibular y rehabilitación vestibular, consideramos que esta propuesta representa un avance significativo dentro de la medicina vestibular moderna. Asimismo, creemos que el reconocimiento formal del mareo residual asociado al VPPB permite superar paradigmas reduccionistas históricamente centrados exclusivamente en la desaparición del nistagmo posicional y favorece una comprensión más amplia de los procesos de compensación vestibular, integración multisensorial y recuperación funcional.
El presente Position Statement surge como un documento de posicionamiento académico y clínico orientado a expresar la visión del grupo colombiano frente al mareo residual asociado al VPPB y discutir críticamente la aplicabilidad clínica del algoritmo CLEAR dentro del contexto colombiano y latinoamericano. En Colombia, el mareo residual asociado al VPPB enfrenta barreras adicionales documentadas, tales como el conocimiento limitado de la patología en la atención primaria y las limitaciones de tiempo de consulta en el actual sistema de salud (4). A esto se suma la alta prevalencia de comorbilidades cardiovasculares y metabólicas que amplifican el riesgo de mareo residual (3) y una cultura clínica que históricamente ha recurrido al uso indiscriminado de supresores vestibulares de manera crónica (4), estrategia que la evidencia actual desaconseja por interferir con la compensación central (3). Con el objetivo de contextualizar esta propuesta, el presente documento resume los principales puntos de posicionamiento del grupo colombiano y sus implicaciones clínicas, así como posibles estrategias de implementación del algoritmo CLEAR a nivel regional.
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