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This article proposes and structures a unifying mechanistic model\u2014the Metabolic Matrix Hypothesis\u2014linking systemic metabolic states to otoconial fragility, and derives testable predictions from it. It is a hypothesis-generating narrative and theoretical synthesis\u2014not a systematic review or meta-analysis\u2014of otoconial matrix biology, otolithic membrane anchoring, endolymph chemistry, and the dispersed clinical literature on metabolic risk factors for BPPV. Evidence supporting each proposed pathway is graded narratively as established clinical association, experimental or animal evidence, mechanistic inference, or speculative extension. In a biologically distinct subset of patients, recurrent idiopathic BPPV may represent the mechanical expression of a systemic metabolic fragility of the otoconia\u2013otolithic membrane\u2013endolymph unit. Vitamin D deficiency, estrogen withdrawal, osteoporosis, insulin resistance, oxidative stress, thyroid autoimmunity, and microvascular insufficiency may act as convergent entry points into impaired matrix resilience rather than independent risks. The model generates testable predictions and a clinically accessible metabolic evaluation for recurrent, bilateral, or multicanal disease, complementing repositioning maneuvers.<\/jats:p>","DOI":"10.1177\/09574271261493213","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T12:32:56Z","timestamp":1791462776000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The metabolic matrix hypothesis of recurrent BPPV: Otoconia\u2013otolithic membrane\u2013endolymph fragility"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6021-7816","authenticated-orcid":false,"given":"Pedro","family":"Stapleton-Garcia","sequence":"first","affiliation":[{"name":"Independent Researcher"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26115"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1155\/2011\/835671"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.3233\/VES-150553"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10194372"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2025.1595693"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2025.1735898"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.3988\/jcn.2025.0439"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/oto2.70209"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/dvdy.24195"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ydbio.2007.01.013"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.heares.2012.07.003"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.heares.2010.05.019"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0012765"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0020498"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0095333"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbagen.2023.130327"},{"key":"e_1_3_6_18_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0175769"},{"issue":"1","key":"e_1_3_6_19_2","first-page":"1","article-title":"Studies on the morphology of the sensory regions of the vestibular apparatus","volume":"42","author":"Lindeman HH","year":"1969","unstructured":"Lindeman HH. 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