Long‐Term Benign Paroxysmal Positional Vertigo: Recurrence, Residual Symptoms and Risk of Falls

OBJECTIVE: To assess long-term outcomes in patients successfully treated for benign paroxysmal positional vertigo, focusing on recurrence rates, residual symptoms, fall risk, and quality of life over a 7-year follow-up period. STUDY DESIGN: Ambispective cohort study combining retrospective data collection with prospective follow-up of the same patient cohort extended through 2024. SETTING: Tertiary referral center treating 361 benign paroxysmal positional vertigo patients between May 2011 and March 2017. METHODS: Patients diagnosed with canalithiasis or cupulolithiasis underwent canal-specific repositioning maneuvers and were followed weekly until symptom resolution. Residual instability was assessed 1 month postresolution using computerized dynamic posturography. Vestibular rehabilitation was administered when indicated. Long-term follow-up included telephone interviews and clinical evaluations, with Dizziness Handicap Inventory scores collected. Statistical analyses examined associations between clinical variables and outcomes including recurrence, residual dizziness, and falls. RESULTS: Mean age was 63.3 ± 15.6 years with female predominance (2.2:1). The posterior canal was most affected (86.7%). Recurrence occurred in 47.1% of patients over 7 years. Residual dizziness increased from 29.6% at 1 month to 37.6% at long-term follow-up. Falls were reported by 18.9% of patients. Requiring multiple repositioning maneuvers (OR = 3.89, P = .033) and vestibular rehabilitation (OR = 2.41, P = .022) predicted recurrence. Residual dizziness was associated with increased fall risk (OR = 5.7, P = .017) and elevated Dizziness Handicap Inventory scores. CONCLUSION: Benign paroxysmal positional vertigo demonstrates significant long-term morbidity despite successful initial treatment, with high recurrence rates and persistent residual symptoms affecting quality of life and increasing fall risk, particularly in elderly patients requiring ongoing monitoring and rehabilitation.