Risk Factors for the Recurrence of Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-Analysis

Ear Nose Throat J. 2022 Mar;101(3):NP112-NP134. doi: 10.1177/0145561320943362. Epub 2020 Aug 10.


Objective: Benign paroxysmal positional vertigo (BPPV) has a high recurrence rate, but the risk factor-associated recurrence are elusive.

Methods: Searches were performed in PubMed, Embase, Cochrane library, Web of science, Chinese National Knowledge Infrastructure, and Sino Med up to November 3, 2019. The effect size was analyzed by odds ratio and 95% CI. Data from eligible studies were meta-analyzed using Stata version 15.0.

Results: Our search resulted in a total of 4076 hits. Twenty-four outcomes of sixty articles were included in the meta-analysis. Risk factors for the recurrence of BPPV included female gender, age (≥65years), hyperlipidemia, diabetes, hypertension, migraine, cervical spondylosis, osteopenia/osteoporosis, head trauma, otitis media, abnormal vestibular evoked myogenic potential, and long use of computers. No significant differences were found in side, type of the involved semicircular canals, smoking, alcohol consumption, stroke, ear surgery, duration of vertigo before treatment, the times of repositioning, Meniere disease, sleep disorders, hypercholesterolemia, and 25-hydroxy vitamin D.

Conclusion: These findings strengthen clinical awareness of early warning to identify patients with potential relapse risk of BPPV and clinicians should counsel patients regarding the importance of follow-up after diagnosis of BPPV.

Keywords: benign paroxysmal positional vertigo; meta-analysis; recurrence; risk factors.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Aged
  • Benign Paroxysmal Positional Vertigo / epidemiology
  • Benign Paroxysmal Positional Vertigo / etiology
  • Female
  • Humans
  • Meniere Disease*
  • Recurrence
  • Risk Factors
  • Semicircular Canals
  • Vestibular Evoked Myogenic Potentials*