Prognosis

Patients need to be educated and reassured about BPPV.[95][42][43] One third of patients remit at 3 weeks and the majority of patients at 6 months from onset.[68][7][43] Patients should be made aware that BPPV is highly treatable, but they should be warned that recurrences are common even after successful treatment with repositioning maneuvers, so further treatments may be required. The published literature varies widely on recurrence rates, with one long-term observational study showing an 18% recurrence rate over 10 years, whereas another study showed a 15% annual recurrence rate, with a 50% recurrence rate at 40 months after treatment.[96][89] Multiple recurrences despite adequate treatment are an indication for referral to a specialist dizziness clinic.

Recurrence of BPPV is a frequent problem. Meniere disease (endolymphatic hydrops), central nervous system diseases, migraine headaches, and post-traumatic BPPV have all been associated with a greater risk of recurrence.[22][23][77][90] The use of vestibular rehabilitation exercises after remission may not prevent recurrences or increase time to recurrence as compared with a control group.[97] Some patients can be taught repositioning maneuvers to use at home when their symptoms recur. The DizzyFIX, which is a new visual analog device designed to aid home treatment of BPPV, may be particularly useful for treating recurrent cases of BPPV.[64]

The surgical treatment of BPPV is reserved for unrelenting and incapacitating cases where repeated attempts with repositioning maneuvers and vestibular rehabilitation exercises have failed.[78][79] Less than 1% of BPPV patients will ever require surgery, but because BPPV is so common, that number of surgical candidates is not negligible.[80]

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