Recurrence of Benign Paroxysmal Positional Vertigo

OBJECTIVE: To determine the recurrence rate of benign positional paroxysmal vertigo (BPPV) and the factors associated to such recurrences. STUDY DESIGN: Prospective study. METHOD: Sixty-nine consecutive patients treated for first episode of BPPV. STUDY PERIOD: 63 months. Mean follow-up: 47 months. RESULTS: The recurrence rate was 27%. Fifty percent of recurrences occurred in the first 6 months. Nineteen patients had 1 or more recurrence of BPPV; 10 had 1 recurrence, 7 patients had 2, and 2 patients had 3 recurrences. There was no significant difference in the recurrence rate according to sex, age, side, cause of BPPV, or instability after successful treatment. Multi-canal BPPV (log-rank, p = 0.024) and anterior canal BPPV (log-rank, p = 0.029) showed a significantly greater tendency to recur and to do so earlier. There was a significant difference in time to recurrence related to the number of maneuvers used to resolve the initial BPPV episode (log-rank, p = 0.023). Except for cases of BPPV secondary to labyrinthitis or neurolabyrinthitis, at least 70% of the recurrences affected a different side and/or different canal than the primary BPPV. CONCLUSION: The recurrence rate of BPPV is 27%, and relapse largely occurs in the first 6 months. When BPPV recurrence is suspected, every canal on both sides must be investigated because it is the BPPV syndrome that recurs, rather than BPPV affecting a particular side or canal. Complex cases of BPPV have a greater risk of recurrence.