For Healthcare Professionals:
The benign paroxysmal positional vertigol (BPLS) is generally considered a „harmless,“ easily treatable condition—after all, with the liberation maneuvers effective and inexpensive therapies are available. However, a recent Taiwanese registry study challenges this picture: people with BPLS have a significantly increased risk of injury over many years—regardless of whether they were treated or not.
🔗 Mao JJ, Lin HC, Lin ST, et al. Incidence of Subsequent Injuries Associated with a New Diagnosis of Benign Paroxysmal Positional Vertigo and Effects of Treatment: A Nationwide Cohort Study. J Clin Med. 2024;13(15):4561.
Original study on PubMed
Study design: 18 years of observation, over 250,000 individuals
The authors evaluated the Taiwanese health insurance database (LHID2005) and identified 50,675 patients with a confirmed BPLS diagnosis (at least 3 documented diagnoses by ENT specialists or neurologists). These were compared to 202,700 control subjects matched by age, gender, and comorbidities without BPLS. The average follow-up period was nearly 15 years.
The central findings
- By the end of the observation period, 26.1 % in the BPLS group had been injured, compared with 17.0 % in the control group.
- After adjustment for age, sex, place of residence, level of care, and comorbidities, the adjusted hazard ratio (aHR) was 2,63 (95 %-KI: 2.49–2.88) for injuries of any kind.
- The most affected were Falls (aHR 3.44) and Traffic accidents (aHR 3.16) – presumably because turning the head while driving can trigger an acute attack.
- Also intentional injuries (e.g., suicide attempts, aHR 1.15) occurred more frequently – an indication of the psychological burden caused by recurrent vertigo.
- A clear one emerged dose-response relationshipThe more frequently BPPV was diagnosed (≥1, ≥2, ≥3 episodes), the higher the risk of injury (aHR 2.04 → 2.47 → 2.63).
- Both minor (ISS < 16) and severe injuries (ISS ≥ 16, polytrauma) were significantly increased in the BPLS group.
The real wake-up call: Treatment alone does not provide sufficient protection
Perhaps the most notable finding is this: the release maneuver (CRT) did not statistically significantly reduce the risk of injury (CRT: aHR 0.78, 95% % CI 0.37–1.29). The authors speculate, among other things, that the database did not contain information on the affected semicircular canal or the exact maneuver technique, and that some of the participants performed the maneuvers only as home exercises without professional guidance —residual dizziness and unsteadiness after acute treatment could therefore continue to contribute to the risk.
Practical relevance
These data highlight what is often neglected in vestibular rehabilitation: purely eliminating symptoms through a repositioning maneuver does not replace structured balance training and fall prevention counseling. Especially older patients with recurrent BPPV benefit from:
- targeted gait and stability analysis, even after successful reduction,
- Information on the increased risk of traffic accidents (keyword: head movements while driving),
- Screening for anxiety and avoidance behavior as well as depressive symptoms,
- a follow-up appointment, instead of discharging the patients „symptom-free“ after the maneuver.
👉 Are you interested in a comprehensive further training in vestibular rehabilitation and want to learn how to safely and sustainably rehabilitate BPLS patients beyond acute treatment?
Current further education opportunities and course dates can be found in the IVRT Course search.
For Patients – Easy to Understand
BPPV is no trifling matter: Why positional vertigo significantly increases the risk of injury
positional vertigo (BPPV) is often described as „harmless“ because it can be treated with a few targeted head and body movements (Repositioning maneuvers) can usually be treated well. However, a large study from Taiwan shows that people who have had BPPV injure themselves significantly more often over the years than people without this condition—even after they have been successfully treated.
📄 Mao JJ, Lin HC, Lin ST, et al. Incidence of Subsequent Injuries Associated with a New Diagnosis of Benign Paroxysmal Positional Vertigo and Effects of Treatment: A Nationwide Cohort Study. J Clin Med. 2024.
What the researchers found out
Over 250,000 people were observed for nearly 15 years. The result: people with BPLS had a 2.6-fold higher risk, to injure themselves, as people without BPPV. Especially frequent were:
- Falls – more than 3 times as frequently as in people without BPLS
- Traffic accidents - also more than 3 times as frequent, presumably because a sudden dizzy spell when turning the head in a car can be very dangerous
And: The more often someone had already experienced positional vertigo, the higher the risk of injury.
Why doesn't the treatment help automatically?
One might assume that a successful repositioning maneuver (e.g., the Epley maneuver) would reduce this risk back to zero. However, the study shows that the risk of injury remained elevated even after treatment. One possible reason: Even after a „successful“ maneuver, many people continue to experience an unsteady gait or a vague sense of unsteadiness for some time—and that is precisely what continues to increase the risk of falling.
What you can do
- Take positional vertigo seriously – even if the individual attack only lasts seconds.
- After performing a recovery maneuver, do not automatically assume that your balance is fully restored. Have a specialized therapist evaluate your gait and stability.
- Be especially careful with quick head movements when driving during the initial period following a BPPV episode.
- If you have experienced positional vertigo repeatedly: actively discuss the increased risk of falls and accidents with your doctor or therapist.
🎯 Our IVRT®-certified dizziness and vestibular therapists support you: Following the successful acute treatment of your positional vertigo, we will help you with targeted Balance and gait training in regaining your safety in daily life and in traffic – so that the treated attack does not become the next fall. Find specialized colleagues in our IVRT therapist search
