What patient factors (age, Meniere’s, head trauma) most strongly predict BPPV recurrence over 3–5 years?

1. Head trauma: a robust, reproducible risk signal

Head trauma—ranging from major blunt injuries to whiplash and minor impacts recorded in clinical history—appears repeatedly as one of the clearest risk factors for recurrent BPPV, shown to increase recurrence risk in long‑term prospective cohorts and systematic reviews, and flagged as strongly associated with both poorer canalith repositioning outcomes and higher relapse rates ^{[1] [3] [5] [4]}.

2. Ménière’s disease: high recurrence risk and treatment complexity

When BPPV coexists with Ménière’s disease it is not only more likely to recur but also often requires more repositioning maneuvers; single‑center long‑term data and multiple reviews report ipsilateral Ménière’s disease as an independent predictor with large effect estimates in some cohorts ^{[1] [2] [6]}, though not every meta‑analysis found a pooled association—reflecting heterogeneity in study design and diagnostic classification ^[5].

3. Age: a real but inconsistent contributor

Advanced age is identified as a risk factor in numerous reviews and some large studies—one institutional series found older adults nearly three times more likely to recur within one year ^[7]—and meta‑analyses and newer reviews list age among significant predictors ^{[5] [4]}. At the same time, several cohort analyses report no independent effect of age after adjusting for comorbidities, and effect sizes for age are generally smaller and more heterogeneous than for trauma or Ménière’s disease, suggesting age may operate partly through comorbid conditions or frailty rather than as a sole causal driver ^{[8] [2] [3]}.

4. How strong is “strong”? Comparing effect sizes and consistency

Quantitatively, studies paint head trauma and Ménière’s disease as the clearest high‑risk flags—prospective 5‑year data linked head trauma and ipsilateral Ménière’s disease to recurrence with statistically significant hazard ratios, and some analyses report very large ORs for Ménière’s (e.g., OR ≈6 in one series) ^{[1] [2]}. By contrast, age often shows modest standardized effects or significance in pooled analyses but is less consistent across individual studies, and multiple reviews emphasize heterogeneity and publication bias for factors including age and trauma ^{[5] [9] [4]}.

5. Why the discrepancies? Study design, definitions and follow‑up matter

Differences in findings reflect variation in follow‑up length (many recurrences cluster within the first year but studies look at 1–5 years), definitions of “head trauma” and Ménière’s, single‑center versus multicenter sampling, and statistical adjustment for comorbidities ^{[1] [8] [10]}. Meta‑analyses also note publication bias and heterogeneity for some predictors, meaning pooled results must be read alongside cohort and prospective studies that control for confounders ^{[5] [9]}.

6. Practical takeaway and limits of the evidence

For counseling and follow‑up planning, the literature supports treating prior head trauma and coexisting Ménière’s disease as high‑risk flags for recurrence over 3–5 years; advanced age should raise vigilance but is a less definitive independent predictor and may reflect associated conditions (osteoporosis, vitamin D deficiency, vascular disease) that themselves affect recurrence risk ^{[1] [3] [4]}. The evidence base is heterogeneous—some sizable meta‑analyses and recent multicenter models point to other contributors (migraine, metabolic disease, osteoporosis, vitamin D) and underscore the need for standardized definitions and longer prospective cohorts to refine absolute risks ^{[8] [3] [4]}.