Vertigo can carry lasting burden even after successful treatment, seven-year study finds

A new long-term study published in Otolaryngology–Head and Neck Surgery, the official peer-reviewed publication of the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF), reveals that benign paroxysmal positional vertigo (BPPV), the most common cause of vertigo, continues to affect patients significantly even years after successful initial treatment. Among 361 patients who followed for seven years, nearly half (47.1%) experienced at least one recurrence, more than a third (37.6%) reported persistent residual dizziness, and nearly one in five (18.9%) suffered a fall.

BPPV is caused by displaced calcium crystals (otoconia) in the inner ear and is typically treated with repositioning maneuvers. While these maneuvers are highly effective in the short term, this study—conducted at Getafe University Hospital in Madrid, Spain—demonstrates that the condition carries meaningful long-term consequences for both clinicians and patients.

These findings align with key recommendations in the AAO-HNSF Clinical Practice Guideline (CPG) update on BPPV. The CPG emphasizes canal-specific repositioning maneuvers as first-line therapy—the same approach used in this study—and addresses patient education, vestibular rehabilitation, and follow-up for those who do not fully resolve after initial treatment.

Additionally, the long-term fall risk documented in this study underscores the importance of the AAO-HNSF's recently awarded grant by the Council of Medical Specialty Societies, with support from The John A. Hartford Foundation, to advance age-friendly care in otolaryngology. This national initiative, which includes fall risk as a key focus area, aims to improve care for older adults by integrating age-friendly principles into otolaryngology practice across the United States.

“Otolaryngologists are on the front lines of addressing some of the most significant health challenges facing older adults, from hearing loss and its connection to cognitive decline to vestibular dysfunction and fall risk,” said Rahul K. Shah, MD, MBA, AAO-HNSF Executive Vice President and CEO. “The CMSS grant allows us to equip our members with specialty-specific, evidence-based tools that continue to put patients at the center of their care—empowering older adults to have more meaningful conversations with their doctors about what matters most to them.”

With BPPV prevalence nearly seven times higher in adults over 60, vestibular disorders represent a critical priority in age-friendly care. The AAO-HNSF initiative will provide clinicians with specialty-specific tools, training, and frameworks to translate evidence like this into practice-level change.

Study Citation: Martin-Sanz, E., Chaure-Cordero, M., Fernández-Navarro, C., Solis-Fesser, A. and Riestra-Ayora, J. (2026), Long-Term Benign Paroxysmal Positional Vertigo: Recurrence, Residual Symptoms and Risk of Falls. Otolaryngol Head Neck Surg. https://doi.org/10.1002/ohn.70257

Otolaryngology–Head and Neck Surgery
Otolaryngology–Head and Neck Surgery (OTO Journal) is the official peer-reviewed publication of the American Academy of Otolaryngology–Head and Neck Surgery Foundation. Our mission is to publish contemporary, ethical, clinically relevant information in otolaryngology, head and neck surgery (ear, nose, throat, head, and neck disorders) that can be used by otolaryngologists, clinicians, scientists, and specialists to improve patient care and public health.

About the AAO-HNS/F
The AAO-HNS/F is one of the world’s largest organizations representing specialists who treat the ears, nose, throat, and related structures of the head and neck. Otolaryngologist-head and neck surgeons diagnose and treat medical disorders that are among the most common affecting patients of all ages in the United States and around the world. Those medical conditions include chronic ear disease, hearing and balance disorders, hearing loss, sinusitis, snoring and sleep apnea, allergies, swallowing disorders, nosebleeds, hoarseness, dizziness, and tumors of the head and neck as well as aesthetic and reconstructive surgery and intricate micro-surgical procedures of the head and neck. The Academy has approximately 13,000 members. The AAO-HNS Foundation works to advance the art, science, and ethical practice of otolaryngology-head and neck surgery through education, research, and quality measurement.