Long-Term BPPV: Recurrence, Residual Symptoms, and Risk of Falls

CLINICAL QUESTION

What are the long-term rates of recurrence, residual dizziness, falls, and quality-of-life impairment after successful treatment of benign paroxysmal positional vertigo (BPPV)?

BOTTOM LINE

Despite successful initial treatment, BPPV was associated with substantial long-term morbidity. Nearly half of patients experienced recurrence over seven years, more than one-third reported residual dizziness, and residual symptoms were strongly associated with falls and greater dizziness-related disability.

BACKGROUND: Canal-specific repositioning maneuvers are effective for BPPV, but some patients continue to experience residual imbalance or later recurrence. Persistent dizziness may affect quality of life and increase fall risk, particularly in older adults.

STUDY DESIGN: An ambispective cohort study incorporating retrospective data collection and prospective follow-up of the same patient cohort through 2024

SETTING: A tertiary referral center that treated 361 patients with BPPV between May 2011 and March 2017

SYNOPSIS: The study included 361 patients with a mean age of 63.3 years, and 69% were women. The posterior canal was affected in 86.7% of cases. Vertigo resolved after one repositioning maneuver in 63.4% of patients, while 36.6% required two or more maneuvers. One month after symptom resolution, 29.6% of patients reported residual disequilibrium. Among these patients, 30 had abnormal computerized dynamic posturography findings and underwent vestibular rehabilitation. Over seven years, 47.1% of patients experienced BPPV recurrence. In 87% of recurrent cases, the same canal was affected. Requiring multiple repositioning maneuvers during the initial episode was associated with higher odds of recurrence (odds ratio [OR], 3.89; P=0.033), as was requiring vestibular rehabilitation (OR, 2.41; P=0.022).

Residual dizziness increased to 37.6% at long-term follow-up. Patients with residual dizziness after initial treatment had substantially higher odds of persistent long-term instability (OR, 4.88; P<0.001). Requiring multiple maneuvers was also associated with long-term residual dizziness (OR, 2.06; P=0.049).

Falls were reported by 18.9% of patients. Residual dizziness was associated with increased fall risk (OR, 5.70; P=0.017), and patients who underwent vestibular rehabilitation also had higher odds of falling (OR, 3.70; P=0.007). Patients with recurrence, residual symptoms, or both had higher Dizziness Handicap Inventory scores than asymptomatic patients.

CITATION: Martin-Sanz E, et al. Long-term benign paroxysmal positional vertigo: recurrence, residual symptoms and risk of falls. Otolaryngol Head Neck Surg. 2026;175:119-125. doi:10.1002/ohn.70257