Understanding the Bigger Picture: How Other Health Conditions Affect BPPV Recovery

We know that Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common causes of dizziness—particularly in adults over 50. While repositioning treatments like the Epley manoeuvre are often effective, the reality is that not everyone gets better right away.

A new systematic review published in Frontiers in Neurology (May 2025) explored why this might be the case. The researchers reviewed over 460 studies to understand how comorbidities (other health conditions) affect both the development of BPPV and how well patients respond to treatment.

Here’s what they found—and what it means for you.

What is BPPV, and How is it Treated?

BPPV occurs when tiny calcium crystals in your inner ear become dislodged and affect your sense of balance. This often results in brief episodes of dizziness triggered by specific head movements.

The gold standard treatment is called a canalith repositioning procedure (CRP), which uses gentle head movements to guide the crystals back to their proper place. For many people, this works the first time—but not for everyone.

Why Do Some People Struggle to Recover from BPPV?

The study found that underlying health conditions play a major role in both causing BPPV and affecting how well someone responds to treatment.

Here are the key findings:

• Head trauma was the most common risk factor for BPPV that didn’t resolve with standard treatment.
• People with conditions like diabetes, high cholesterol, thyroid disorders, osteoporosis, and cardiovascular issues were also more likely to develop BPPV or need multiple treatments to recover.
• Anxiety, depression, obesity, and low vitamin D levels were also linked to worse outcomes.
• In some cases, up to 18 repositioning sessions were needed for full recovery—particularly when other conditions were present.

How Equilibrium Audiology Can Help

We take a holistic approach to vestibular health. That means we don’t just look at your symptoms—we look at your full health profile, including:

• Metabolic health (e.g., blood sugar, cholesterol)
• Hormonal function (e.g., thyroid)
• Vitamin and mineral levels (e.g., vitamin D)
• History of migraines, trauma, or anxiety
• Neurological status

With this full picture in mind, we customize your care using:

• Advanced vestibular testing
• Tailored canalith repositioning techniques
• Lifestyle and functional medicine coaching
• Nutritional recommendations (e.g., supporting vitamin D levels or reducing inflammation)
• Collaboration with your GP or specialist team

The Takeaway

If you’re struggling with recurring or stubborn BPPV, it’s important to ask: “What else could be going on in my body?”

At Equilibrium Audiology, we’re here to help you explore that question and recover more completely—because dizziness is rarely just about the ears.

Need support with BPPV? Book a comprehensive vestibular evaluation with our team today. Let’s get to the root cause and get you back in balance.