What are the long‑term recurrence rates of BPPV after clinic Epley versus home exercises over 3–5 years?
Executive summary
Clinic-applied Epley (canalith repositioning) reliably cures posterior‑canal BPPV in the short term, but recurrence remains common over years — roughly 15% per year and about half of patients by 3–5 years in multiple reports [1] [2]. Randomized trials and cohort studies show that Brandt‑Daroff or other home exercise programs often achieve similar long‑term recurrence rates to clinic Epley when followed for 1–4 years, while adding regular self‑treatment after an initial Epley appears to reduce recurrences compared with single‑session clinic Epley alone [3] [4] [5].
1. What the question actually asks and what the evidence can answer
The question seeks a comparative long‑term recurrence rate (3–5 years) between clinic Epley maneuvers and home exercises; available published data include randomized trials and cohort follow‑ups extending from 12 months up to 48 months but few large multicenter trials specifically powered for multi‑year recurrence comparisons, so conclusions must be drawn from several smaller studies and reviews rather than a single definitive trial [3] [5] [6].
2. Clinic Epley: expected multi‑year recurrence rates
Clinic‑delivered Epley or modified canalith repositioning procedures achieve high immediate cure rates and are repeatedly documented to leave a substantial residual long‑term recurrence risk — about 15% per year in Kaplan‑Meier analyses and approximately 30% at one year and near 50% by around four to five years in observational series [1] [2] [7].
3. Home exercises (Brandt‑Daroff, self‑Epley, half‑somersault) and their long‑term outcomes
Trials comparing home programs to clinic maneuvers show mixed short‑term speed of recovery but similar recurrence over months to years: randomized prospective work found Brandt‑Daroff and modified Epley cured essentially the same proportion by three weeks and showed similar recurrence over 12–24 months [3], while other comparative studies reported no statistically significant difference in recurrence at six months between Epley and Brandt‑Daroff [4]. Home self‑treatment strategies (daily or on‑recurrence self‑Epley / half‑somersault) have been associated with good control of recurrent episodes and, in some series, fewer clinic returns — for example, home self‑treatment combined with initial Epley gave superior sustained outcomes versus Epley alone in cohort data [5] [8].
4. Comparative trials, augmentations and caveats
Direct head‑to‑head randomized trials with multi‑year recurrence endpoints are limited; small RCTs show faster symptom relief with clinic Epley early on, similar recurrence thereafter when compared with Brandt‑Daroff over months, and device‑augmented Epley (Dizzy‑Fix) reduced 1‑month recurrences in one RCT but does not provide multi‑year data [6] [3] [4]. Meta‑analytic reviews and clinical reviews emphasize that recurrence is influenced by patient factors (Meniere’s disease, age, prior events) and by whether patients perform ongoing self‑treatment — studies note that routine daily Brandt‑Daroff for years did not uniformly prevent recurrence, while targeted self‑repositioning after recurrence may be effective [7] [9] [5].
5. Practical synthesis and limits of the evidence
Across the literature, clinic Epley produces rapid resolution but does not eliminate long‑term recurrence: expect roughly 15% per year and about 40–50% of patients having at least one recurrence within 3–5 years in observational series [1] [2]. Home exercises (Brandt‑Daroff or self‑Epley/half‑somersault) yield similar long‑term recurrence rates in randomized and comparative studies over months to a few years, and combining initial clinic Epley with taught self‑treatment appears to reduce recurrences or clinic visits in several reports [3] [4] [5]. Confidence is limited by small sample sizes, heterogeneous protocols (type/frequency of home exercise), variable follow‑up durations, and possible selection bias in nonrandomized cohorts; large multicenter trials with standardized long‑term follow‑up would be needed for a definitive numeric comparison across 3–5 years [10] [5].