Seasonal variation in climate, air pollution, and the incidence of benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV) represents the most prevalent etiology of vertigo encountered in clinical practice. This study aims to evaluate the associations of seasonality in climate, air pollution, and the incidence of BPPV in Taiwan from 2002 to 2021. Data on BPPV cases were extracted from the Longitudinal Health Insurance Database 2010. We calculated the monthly incidence rates of BPPV episodes per 100,000 participants over a 240-month period, categorizing the data by gender and age groups: 18-44, 45-64, and 65 and above. Meteorological variables (temperature, atmospheric pressure, humidity, precipitation, sunshine duration) and air pollutants (NO₂, SO₂, CO, O₃, PM₁₀) were obtained from national monitoring networks. Auto-Regressive Moving Average (ARMA) models were employed to assess associations between environmental variables, seasonality, and BPPV incidence. BPPV incidence increased significantly over two decades across all age and sex groups. The ARMA regression models suggested that elevated temperature, atmospheric pressure, and NO₂ levels were significantly correlated with higher BPPV incidence, whereas sunshine duration showed no effect. Moreover, the ARMA regression models consistently show that Spring exhibited a greater monthly incidence of BPPV compared to winter across different sex and age categories. BPPV incidence shows significant population-level associations with climatic and air-quality factors. Elevated temperature, atmospheric pressure, and NO₂ exposure may be associated with otoconial instability, emphasizing the need to consider environmental conditions in BPPV prevention and clinical management.