OBJECTIVE: This study aims to investigate the factors influencing RD in elderly patients with BPPV following successful manual reduction. METHODS: A total of 112 elderly patients diagnosed with benign paroxysmal positional vertigo (BPPV) were selected. The patients' general information, comorbidities, and scores on the Dizziness Handicap Inventory (DHI) were recorded. Following a successful canalith repositioning procedure (CRP), bone mineral density (BMD) was assessed using dual-energy X-ray absorptiometry and evaluated with the T-score. The mean blood flow velocity (Vm) and pulse index (PI) of the bilateral middle cerebral arteries (MCA) and basilar artery (BA) were measured using transcranial Doppler (TCD). Cerebrovascular reactivity (CVR) was evaluated through the Breath Holding Index (BHI). White matter lesions are assessed using cranial Magnetic Resonance Imaging (MRI) and evaluated with the Leukoaraiosis score (LA-score). The patients were divided into residual dizziness (RD) and non-RD groups based on the presence of RD one week after the reduction. The effects of bone mineral density, cerebral blood flow, and cerebral white matter on short-term RD in elderly BPPV patients were subsequently evaluated. RESULTS: In the RD group, the DHI and LA-score were significantly higher than those in the non-RD group, while the T-score and BHI were lower, with statistically significant differences between the two groups (P <
0.05). The decreases in BHI and T-score, along with the increases in DHI and LA-score, were identified as risk factors for short-term RD following reduction in elderly patients with BPPV. Multivariate logistic regression analysis indicated that BHI, T-score, and LA-score were independent risk factors for RD. T-score and BHI exhibited a negative correlation with RD, while LA-score demonstrated a positive correlation. The diagnostic performance of each indicator was evaluated using ROC curve analysis. The results showed that the AUC for BHI was 0.715, T-score was 0.730, and LA-score was 0.732. Notably, when the three indicators were combined, the AUC significantly increased to 0.842, demonstrating high diagnostic efficiency, with a sensitivity of 70.73 % and a specificity of 90.14 %. CONCLUSION: The decreases in the BHI and T-score, along with the increases in the DHI and LA-score, are all identified as risk factors for short-term RD following reduction in elderly patients with BPPV. BHI, T-score, and LA-score serve as independent risk factors for RD and can effectively predict its occurrence, with their combined predictive value being superior. BMD, CVR, and LA were utilized to predict short-term RD after successful manual reduction of BPPV.