How often BPPV returns
A successful Epley manoeuvre moves the displaced crystals out of the canal, but it does not stop new crystals from breaking free later. Follow-up studies report recurrence in roughly 15 to 20 per cent of people within the first year and around 40 to 50 per cent over five years or more. Recurrence is more common in older adults, in people with a history of head injury, migraine or Meniere's disease, and in those whose first episode involved both ears.
What a recurrence feels like
The same brief spinning triggered by the same kinds of movement, often on the same side as before, although it can switch sides. Because you will recognise it, most people seek treatment sooner the second time and recover faster.
How it is treated
Exactly as the first time: a positional test to confirm the ear and canal, then the appropriate repositioning manoeuvre. There is no reason to expect a recurrence to be harder to treat. If you have had clinician-guided treatment before and the same side recurs, a home Epley for that side is reasonable, provided you were shown how to do it correctly and the symptoms match.
Reducing recurrence
Some measures have evidence behind them. Low vitamin D has been associated with BPPV recurrence in several studies, and correcting a deficiency appears to reduce repeat episodes in people who were deficient, so a blood test is worth considering if you have had more than one bout. Managing migraine, where present, reduces vestibular symptoms generally. Older advice to sleep propped up or avoid the affected side for days after treatment has not been shown to help and is no longer recommended. Staying generally active and keeping the head moving normally is better than avoiding movement.
When recurrence needs a second look
If episodes become frequent, if the pattern changes, if hearing is affected, or if the manoeuvre stops working, a fresh assessment is needed to check whether a different canal is involved or whether something other than BPPV is contributing.
At Omnia
Vestibular First at our Chiswick clinic treats recurrent BPPV, teaches you a home manoeuvre for your confirmed side where appropriate, and can arrange a vitamin D check through our Randox blood testing service if repeated episodes suggest it would be useful.