Less Common Variants of Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo: Diagnostic and Therapeutic Considerations

<b>Background:</b> Posterior canal benign paroxysmal positional vertigo (PSC-BPPV) is the most frequently encountered vestibular disorder in otoneurological clinical practice. However, diagnosis may be challenging in the presence of less common variants, which are characterised by atypical nystagmus patterns and may complicate clinical assessment. <b>Methods:</b> This study analysed a cohort of 295 patients diagnosed with PSC-BPPV and treated between January and August 2025 at the Audiology and Phoniatrics Unit of San Pio Hospital, Benevento. Of these, 25 patients presented with less common PSC-BPPV variants, namely the apogeotropic variant, the Scocco variant, and the Yetiser variant. Clinical features, therapeutic manoeuvres performed, time to symptom resolution, and associated comorbidities were evaluated. All patients were treated exclusively using the Epley manoeuvre. This observational study describes our experience in the diagnosis and management of these rare PSC-BPPV variants, with the aim of expanding the currently available evidence. <b>Results:</b> The Scocco variant was the only less common form of PSC-BPPV that required a statistically significantly greater number of liberatory manoeuvres when compared with classic PSC-BPPV (<i>p</i> < 0.05). No statistically significant differences were observed for the remaining variants with regard to treatment response or time to symptom resolution. <b>Conclusions:</b> Less common variants of PSC-BPPV represent both diagnostic and therapeutic challenges due to their atypical nystagmus patterns. Our findings indicate that the Scocco variant may be more resistant to standard liberatory treatment. In addition, this study reports auxiliary diagnostic and clinical tools which, in our experience, facilitated patient management.