Skip to main content

Advertisement

SpringerLink
Log in

Risk factors for benign paroxysmal positional vertigo recurrence: a systematic review and meta-analysis

  • Review
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Background and purpose

Benign paroxysmal positional vertigo is one of the most common vestibular diseases, especially in the elderly. Although the treatment of BPPV is relatively successful, many patients suffer recurrence after treatment. Therefore, identifying potential risk factors for BPPV recurrence may help improve treatment outcome and patient prognosis. However, some related risk factors for BPPV recurrence are relatively controversial and poorly studied. This meta-analysis aims to identify potential risk factors associated with BPPV recurrence, thereby reducing the recurrence rate of BPPV and improving the prognosis of patients.

Methods

This meta-analysis was conducted through systematically searching PubMed, Embase, and the Cochrane Library for eligible English original studies published up to June 2020. All search results were reviewed based on our inclusion and exclusion criteria. We calculated the pooled odds ratios (ORs) or the mean differences (MDs) with their corresponding 95% confidence intervals (CIs) to evaluate the effects of included risk factors on BPPV recurrence.

Results

A total of 14 studies involving 3060 BPPV patients published between 2010 and 2019 were finally included, including six prospective studies and eight retrospective studies, with a NOS score ranged from 6 to 9. Our pooled results of this meta-analysis suggested that the recurrence of BPPV was closely related to female gender (OR = 1.42; 95% CI 1.17–1.74; P = 0.0004), hypertension (OR = 2.61; 95% CI 1.22–5.59; P = 0.01), diabetes mellitus (OR = 2.62; 95% CI 1.25–5.48; P = 0.01), hyperlipidemia (OR = 1.60; 95% CI 1.23–2.09; P = 0.0006), osteoporosis (OR = 1.72; 95% CI 1.03–2.88; P = 0.04) and vitamin D deficiency (MD = − 3.29; 95% CI − 5.32 to − 1.26; P = 0.001).

Conclusion

This meta-analysis indicated that female gender, hypertension, diabetes mellitus, hyperlipidemia, osteoporosis, and vitamin D deficiency were risk factors for BPPV recurrence. However, the effects of other potential risk factors including advanced age, migraine, head trauma, and Menière’s disease on BPPV recurrence need further investigations. Furthermore, most studies included in this meta-analysis were performed in Asia, so our results cannot easily be extended to the whole world population. Therefore, more large-scale prospective studies in different countries are required to further investigate these risk factors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. De Stefano A, Dispenza F, Citraro L, Petrucci AG, Di Giovanni P, Kulamarva G, Mathur N, Croce A (2011) Are postural restrictions necessary for management of posterior canal benign paroxysmal positional vertigo? Ann Otol Rhinol Laryngol 120(7):460–464. https://doi.org/10.1177/000348941112000707

    Article  PubMed  Google Scholar 

  2. von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T, Neuhauser H (2007) Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry 78(7):710–715. https://doi.org/10.1136/jnnp.2006.100420

    Article  Google Scholar 

  3. Baloh RW, Honrubia V, Jacobson K (1987) Benign positional vertigo: clinical and oculographic features in 240 cases. Neurology 37(3):371–378. https://doi.org/10.1212/wnl.37.3.371

    Article  CAS  PubMed  Google Scholar 

  4. Kao CL, Cheng YY, Leu HB, Chen TJ, Ma HI, Chen JW, Lin SJ, Chan RC (2014) Increased risk of ischemic stroke in patients with benign paroxysmal positional vertigo: a 9-year follow-up nationwide population study in taiwan. Front Aging Neurosci 6:108. https://doi.org/10.3389/fnagi.2014.00108

    Article  PubMed  PubMed Central  Google Scholar 

  5. Liao WL, Chang TP, Chen HJ, Kao CH (2015) Benign paroxysmal positional vertigo is associated with an increased risk of fracture: a population-based cohort study. J Orthop Sports Phys Ther 45(5):406–412. https://doi.org/10.2519/jospt.2015.5707

    Article  PubMed  Google Scholar 

  6. Lo MH, Lin CL, Chuang E, Chuang TY, Kao CH (2017) Association of dementia in patients with benign paroxysmal positional vertigo. Acta Neurol Scand 135(2):197–203. https://doi.org/10.1111/ane.12581

    Article  PubMed  Google Scholar 

  7. Brandt T, Huppert D, Hecht J, Karch C, Strupp M (2006) Benign paroxysmal positioning vertigo: a long-term follow-up (6–17 years) of 125 patients. Acta Otolaryngol 126(2):160–163. https://doi.org/10.1080/00016480500280140

    Article  PubMed  Google Scholar 

  8. Chen J, Zhao W, Yue X, Zhang P (2020) Risk factors for the occurrence of benign paroxysmal positional vertigo: a systematic review and meta-analysis. Front Neurol 11:506. https://doi.org/10.3389/fneur.2020.00506

    Article  PubMed  PubMed Central  Google Scholar 

  9. Wu Y, Gu C, Han W, Lu X, Chen C, Fan Z (2018) Reduction of bone mineral density in native Chinese female idiopathic benign paroxysmal positional vertigo patients. Am J Otolaryngol 39(1):31–33. https://doi.org/10.1016/j.amjoto.2017.09.004

    Article  PubMed  Google Scholar 

  10. Kim SY, Han SH, Kim YH, Park MH (2017) Clinical features of recurrence and osteoporotic changes in benign paroxysmal positional vertigo. Auris Nasus Larynx 44(2):156–161. https://doi.org/10.1016/j.anl.2016.06.006

    Article  PubMed  Google Scholar 

  11. Zhu CT, Zhao XQ, Ju Y, Wang Y, Chen MM, Cui Y (2019) Clinical Characteristics and Risk Factors for the Recurrence of Benign Paroxysmal Positional Vertigo. Front Neurol 10:1190. https://doi.org/10.3389/fneur.2019.01190

    Article  PubMed  PubMed Central  Google Scholar 

  12. Yamanaka T, Shirota S, Sawai Y, Murai T, Fujita N, Hosoi H (2013) Osteoporosis as a risk factor for the recurrence of benign paroxysmal positional vertigo. Laryngoscope 123(11):2813–2816. https://doi.org/10.1002/lary.24099

    Article  PubMed  Google Scholar 

  13. Su P, Liu YC, Lin HC (2016) Risk factors for the recurrence of post-semicircular canal benign paroxysmal positional vertigo after canalith repositioning. J Neurol 263(1):45–51. https://doi.org/10.1007/s00415-015-7931-0

    Article  PubMed  Google Scholar 

  14. Sreenivas V, Sima NH, Philip S (2019) The role of comorbidities in benign paroxysmal positional vertigo. Ear Nose Throat J. https://doi.org/10.1177/0145561319878546

    Article  PubMed  Google Scholar 

  15. Rhim GI (2019) Serum vitamin D and long-term outcomes of benign paroxysmal positional vertigo. Clin Exp Otorhinolaryngol 12(3):273–278. https://doi.org/10.21053/ceo.2018.00381

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Rhim GI (2016) Serum vitamin D and recurrent benign paroxysmal positional vertigo. Laryngoscope Investing Otolaryngol 1(6):150–153. https://doi.org/10.1002/lio2.35

    Article  Google Scholar 

  17. Kansu L, Avci S, Yilmaz I, Ozluoglu LN (2010) Long-term follow-up of patients with posterior canal benign paroxysmal positional vertigo. Acta Otolaryngol 130(9):1009–1012. https://doi.org/10.3109/00016481003629333

    Article  PubMed  Google Scholar 

  18. Wang Y, Xia F, Wang W, Hu W (2018) Assessment of sleep quality in benign paroxysmal positional vertigo recurrence. Int J Neurosci 128(12):1143–1149. https://doi.org/10.1080/00207454.2018.1486835

    Article  CAS  PubMed  Google Scholar 

  19. Do YK, Kim J, Park CY, Chung MH, Moon IS, Yang HS (2011) The effect of early canalith repositioning on benign paroxysmal positional vertigo on recurrence. Clin Exp Otorhinolaryngol 4(3):113–117. https://doi.org/10.3342/ceo.2011.4.3.113

    Article  PubMed  PubMed Central  Google Scholar 

  20. Talaat HS, Abuhadied G, Talaat AS, Abdelaal MSS (2015) Low bone mineral density and vitamin D deficiency in patients with benign positional paroxysmal vertigo. Eur Arch Otorhinolaryngol 272(9):2249–2253. https://doi.org/10.1007/s00405-014-3175-3

    Article  PubMed  Google Scholar 

  21. Webster G, Sens PM, Salmito MC, Cavalcante JDR, dos Santos PRB, da Silva ALM, de Souza TCF (2015) Hyperinsulinemia and hyperglycemia: risk factors for recurrence of benign paroxysmal positional vertigo. Braz J Otorhinolaryngol 81(4):347–351. https://doi.org/10.1016/j.bjorl.2014.09.008

    Article  PubMed  Google Scholar 

  22. Lee JD, Park MK, Lee BD, Lee TK, Sung KB, Park JY (2013) Abnormality of cervical vestibular-evoked myogenic potentials and ocular vestibular-evoked myogenic potentials in patients with recurrent benign paroxysmal postitional vertigo. Acta Otolaryngol 133(2):150–153. https://doi.org/10.3109/00016489.2012.723823

    Article  PubMed  Google Scholar 

  23. Babac S, Djeric D, Petrovic-Lazic M, Arsovic N, Mikic A (2014) Why do treatment failure and recurrences of benign paroxysmal positional vertigo occur? Otol Neurotol 35(6):1105–1110. https://doi.org/10.1097/mao.0000000000000417

    Article  PubMed  Google Scholar 

  24. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. JAMA 283(15):2008–2012. https://doi.org/10.1001/jama.283.15.2008

    Article  CAS  PubMed  Google Scholar 

  25. Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25(9):603–605. https://doi.org/10.1007/s10654-010-9491-z

    Article  PubMed  Google Scholar 

  26. Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558. https://doi.org/10.1002/sim.1186

    Article  PubMed  Google Scholar 

  27. Dai Q, Chen Q, Yin L, Zheng H, Liu SX, Duan M (2020) The long-term follow-up of 61 horizontal canal BPPV after Gufoni and Barbecue maneuver: a prospective study. Acta Otolaryngol 140(6):463–466. https://doi.org/10.1080/00016489.2020.1725114

    Article  PubMed  Google Scholar 

  28. Luryi AL, Lawrence J, Bojrab DI, LaRouere M, Babu S, Zappia J, Sargent EW, Chan E, Naumann I, Hong RS, Schutt CA (2018) Recurrence in benign paroxysmal positional vertigo: a large single-institution study. Otol Neurotol 39(5):622–627. https://doi.org/10.1097/mao.0000000000001800

    Article  PubMed  Google Scholar 

  29. Yang H, Gu H, Sun W, Li Y, Wu H, Burnee M, Zhuang J (2018) Estradiol deficiency is a risk factor for idiopathic benign paroxysmal positional vertigo in postmenopausal female patients. Laryngoscope 128(4):948–953. https://doi.org/10.1002/lary.26628

    Article  PubMed  Google Scholar 

  30. Vibert D, Kompis M, Häusler R (2003) Benign paroxysmal positional vertigo in older women may be related to osteoporosis and osteopenia. Ann Otol Rhinol Laryngol 112(10):885–889. https://doi.org/10.1177/000348940311201010

    Article  PubMed  Google Scholar 

  31. De Stefano A, Dispenza F, Suarez H, Perez-Fernandez N, Manrique-Huarte R, Ban JH, Kim MB, Strupp M, Feil K, Oliveira CA, Sampaio AL, Araujo MFS, Bahmad F, Ganança MM, Ganança FF, Dorigueto R, Lee H, Kulamarva G, Mathur N, Di Giovanni P, Petrucci AG, Staniscia T, Citraro L, Croce A (2014) A multicenter observational study on the role of comorbidities in the recurrent episodes of benign paroxysmal positional vertigo. Auris Nasus Larynx 41(1):31–36. https://doi.org/10.1016/j.anl.2013.07.007

    Article  PubMed  Google Scholar 

  32. Cohen HS, Kimball KT, Stewart MG (2004) Benign paroxysmal positional vertigo and comorbid conditions. ORL J Otorhinolaryngol Relat Spec 66(1):11–15. https://doi.org/10.1159/000077227

    Article  PubMed  Google Scholar 

  33. D'Silva LJ, Staecker H, Lin J, Sykes KJ, Phadnis MA, McMahon TM, Connolly D, Sabus CH, Whitney SL, Kluding PM (2016) Retrospective data suggests that the higher prevalence of benign paroxysmal positional vertigo in individuals with type 2 diabetes is mediated by hypertension. J Vestib Res 25(5–6):233–239. https://doi.org/10.3233/ves-150563

    Article  PubMed  PubMed Central  Google Scholar 

  34. Ishiyama A, Jacobson KM, Baloh RW (2000) Migraine and benign positional vertigo. Ann Otol Rhinol Laryngol 109(4):377–380. https://doi.org/10.1177/000348940010900407

    Article  CAS  PubMed  Google Scholar 

  35. Hilton DB, Luryi AL, Bojrab DI, Babu SC, Hong RS, Bojrab DI 2nd, Santiago Rivera OJ, Schutt CA (2020) Comparison of associated comorbid conditions in patients with benign paroxysmal positional vertigo with or without migraine history: a large single institution study. Am J Otolaryngol 41(6):102650. https://doi.org/10.1016/j.amjoto.2020.102650

    Article  PubMed  Google Scholar 

  36. Teixido M, Baker A, Isildak H (2017) Migraine and benign paroxysmal positional vertigo: a single-institution review. J Laryngol Otol 131(6):508–513. https://doi.org/10.1017/s0022215117000536

    Article  CAS  PubMed  Google Scholar 

  37. Prokopakis EP, Chimona T, Tsagournisakis M, Christodoulou P, Hirsch BE, Lachanas VA, Helidonis ES, Plaitakis A, Velegrakis GA (2005) Benign paroxysmal positional vertigo: 10-year experience in treating 592 patients with canalith repositioning procedure. Laryngoscope 115(9):1667–1671. https://doi.org/10.1097/01.mlg.0000175062.36144.b9

    Article  PubMed  Google Scholar 

  38. Balatsouras DG, Ganelis P, Aspris A, Economou NC, Moukos A, Koukoutsis G (2012) Benign paroxysmal positional vertigo associated with Meniere's disease: epidemiological, pathophysiologic, clinical, and therapeutic aspects. Ann Otol Rhinol Laryngol 121(10):682–688. https://doi.org/10.1177/000348941212101011

    Article  PubMed  Google Scholar 

  39. Hughes CA, Proctor L (1997) Benign paroxysmal positional vertigo. Laryngoscope 107(5):607–613. https://doi.org/10.1097/00005537-199705000-00010

    Article  CAS  PubMed  Google Scholar 

  40. Karlberg M, Hall K, Quickert N, Hinson J, Halmagyi GM (2000) What inner ear diseases cause benign paroxysmal positional vertigo? Acta Otolaryngol 120(3):380–385. https://doi.org/10.1080/000164800750000603

    Article  CAS  PubMed  Google Scholar 

  41. Lee NH, Ban JH, Lee KC, Kim SM (2010) Benign paroxysmal positional vertigo secondary to inner ear disease. Otolaryngol Head Neck surg 143(3):413–417. https://doi.org/10.1016/j.otohns.2010.06.905

    Article  PubMed  Google Scholar 

  42. Kutlubaev MA, Xu Y, Hornibrook J (2019) Benign paroxysmal positional vertigo in Meniere's disease: systematic review and meta-analysis of frequency and clinical characteristics. J Neurol. https://doi.org/10.1007/s00415-019-09502-x

    Article  PubMed  Google Scholar 

  43. Yu S, Liu F, Cheng Z, Wang Q (2014) Association between osteoporosis and benign paroxysmal positional vertigo: a systematic review. BMC Neurol 14:110. https://doi.org/10.1186/1471-2377-14-110

    Article  PubMed  PubMed Central  Google Scholar 

  44. Mikulec AA, Kowalczyk KA, Pfitzinger ME, Harris DA, Jackson LE (2010) Negative association between treated osteoporosis and benign paroxysmal positional vertigo in women. J Laryngol Otol 124(4):374–376. https://doi.org/10.1017/s002221510999209x

    Article  CAS  PubMed  Google Scholar 

  45. Yang B, Lu Y, Xing D, Zhong W, Tang Q, Liu J, Yang X (2020) Association between serum vitamin D levels and benign paroxysmal positional vertigo: a systematic review and meta-analysis of observational studies. Eur Arch Otorhinolaryngol 277(1):169–177. https://doi.org/10.1007/s00405-019-05694-0

    Article  PubMed  Google Scholar 

  46. Minasyan A, Keisala T, Zou J, Zhang Y, Toppila E, Syvälä H, Lou YR, Kalueff AV, Pyykkö I, Tuohimaa P (2009) Vestibular dysfunction in vitamin D receptor mutant mice. J Steroid Biochem Mol Biol 114(3–5):161–166. https://doi.org/10.1016/j.jsbmb.2009.01.020

    Article  CAS  PubMed  Google Scholar 

  47. Büki B, Ecker M, Jünger H, Lundberg YW (2013) Vitamin D deficiency and benign paroxysmal positioning vertigo. Med Hypotheses 80(2):201–204. https://doi.org/10.1016/j.mehy.2012.11.029

    Article  CAS  PubMed  Google Scholar 

  48. Gu X, Dong F, Gu J (2018) Analysis of effect of 1α-hydroxyvitamin D3 on benign paroxysmal positional vertigo and risk factors. Exp Ther Med 15(3):2321–2326. https://doi.org/10.3892/etm.2018.5699

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Pollak L, Kushnir M, Goldberg HS (2011) Physical inactivity as a contributing factor for onset of idiopathic benign paroxysmal positional vertigo. Acta Otolaryngol 131(6):624–627. https://doi.org/10.3109/00016489.2011.552524

    Article  PubMed  Google Scholar 

  50. Aksoy S, Sennaroğlu L (2007) Benign paroxysmal positional vertigo in swimmers. Kulak Burun Bogaz Ihtis Derg 17(6):307–310

    PubMed  Google Scholar 

  51. Vibert D, Redfield RC, Häusler R (2007) Benign paroxysmal positional vertigo in mountain bikers. Ann Otol Rhinol Laryngol 116(12):887–890. https://doi.org/10.1177/000348940711601203

    Article  PubMed  Google Scholar 

  52. Helminski JO, Janssen I, Hain TC (2008) Daily exercise does not prevent recurrence of benign paroxysmal positional vertigo. Otol Neurotol 29(7):976–981. https://doi.org/10.1097/MAO.0b013e318184586d

    Article  PubMed  Google Scholar 

  53. Balatsouras DG, Koukoutsis G, Fassolis A, Moukos A, Apris A (2018) Benign paroxysmal positional vertigo in the elderly: current insights. Clin Interv Aging 13:2251–2266. https://doi.org/10.2147/cia.S144134

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, The First Clinic College of Xinxiang Medical University, Xinxiang, 453000, Henan, China

    Jinbao Chen, Senlin Zhang & Kai Cui

  2. Department of Imaging, The First Clinic College of Xinxiang Medical University, Xinxiang, 453000, Henan, China

    Chuxuan Liu

Authors
  1. Jinbao Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Senlin Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kai Cui
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chuxuan Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JC, SZ, KC, and CL: literature search, data extraction, statistical analysis, drafting and revision of the manuscript. JC, and SZ: critical revision of the manuscript.

Corresponding author

Correspondence to Jinbao Chen.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflicts of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 13 kb)

Supplementary file2 (DOCX 329 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chen, J., Zhang, S., Cui, K. et al. Risk factors for benign paroxysmal positional vertigo recurrence: a systematic review and meta-analysis. J Neurol 268, 4117–4127 (2021). https://doi.org/10.1007/s00415-020-10175-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-020-10175-0

Keywords

Search

Navigation