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Abstract
OBJECTIVE Low vitamin D levels have been associated with and could play a role in the pathogenesis of idiopathic benign paroxysmal positional vertigo (iBPPV). Since otoconia degeneration contributes to iBPPV and a lack of vitamin D may impact otoconia structure and integrity, we proposed a negative association between vitamin D levels and levels of a proposed circulatory biomarker for otolithic degeneration, otolin-1. STUDY DESIGN Cross-sectional clinical study. SETTING Clinical research center. PATIENTS Seventy-nine men and women ranging in age from 22 to 95 years old without known vertigo. INTERVENTIONS Diagnostic. MAIN OUTCOME MEASURES Blood levels of 25-OH vitamin D and otolin-1. RESULTS Previously, we had reported higher otolin-1 levels in older age groups. The majority of the subjects (83%) had vitamin D levels that were below 40 ng/ml. Vitamin D level was lowest in the young and increased with age before declining in subjects 70 years of age and older (p = 0.005). There was a negative correlation between vitamin D and otolin-1 levels of subjects over 70 (r = -0.36, p = 0.036). CONCLUSION Our results demonstrate a relationship between vitamin D and otolin-1. The majority of our subjects had abnormally low vitamin D levels, but only those over 70 years of age showed a negative correlation with high otolin-1 levels. We postulate that a seasonal drop in vitamin D may not be sufficient for otoconia fragmentation and ultimately iBPPV, rather, chronically low vitamin D maybe required to induce otoconia degeneration.
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Barometric pressure and the incidence of benign paroxysmal positional vertigo. Am J Otolaryngol 2019; 40:641-644. [PMID: 31147143 DOI: 10.1016/j.amjoto.2019.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/14/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To investigate the relationship between barometric pressure and the incidence of benign paroxysmal positional vertigo (BPPV). METHODS 181 patients diagnosed with classic BPPV seen between 2011 and 2016 were identified. Demographic information, data of onset, and date of presentation were recorded. Historical barometric data for each of the 60 months were recorded. In addition, monthly counts of other atmospheric, infectious, and allergic variables for that time period were recorded. Correlation analysis compared monthly incidence of BPPV with absolute and relative changes in atmospheric conditions. RESULTS The incidence of BPPV onset demonstrated a statistically significant positive correlation with barometric pressure, where every one-unit increase in barometric pressure leads to an expected increase of 6.1 diagnoses (p = 0.0008). The correlation coefficient (r) between barometric pressure and BPPV diagnoses was 0.66 (95% CI 0.14-0.90) with a p-value of 0.0131. Other seasonal variables demonstrated correlation, though none as strong as barometric pressure. CONCLUSIONS Barometric pressure has been long been associated with conditions of the inner ear, though its relationship to the pathogenesis of BPPV has not been investigated. Monthly changes in barometric pressure, rather than the absolute value, may be responsible for the observed changes in incidence. These findings demonstrate a clear association between barometric pressure and BPPV that may help to explain both the etiology of BPPV and its possible connection to migraine-related conditions.
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Kaplan DM, Nash M, Niv A, Kraus M. Management of Bilateral Benign Paroxysmal Positional Vertigo. Otolaryngol Head Neck Surg 2019; 133:769-73. [PMID: 16274807 DOI: 10.1016/j.otohns.2005.07.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2004] [Indexed: 11/24/2022]
Abstract
Objective To describe a series of patients with bilateral benign paroxysmal positional vertigo (BiBPPV), with respect to demographics, management, and outcome. Methods All patients who were identified and treated for BiBPPV in a previous 36-month period with a minimal follow-up period of 6 months were included. Patients were treated with Epley's maneuver (EM) on the side that was more symptomatic and that had a greater velocity and amplitude of tortional nystagmus. Patients were re-treated according to symptoms and findings on follow-up visits. Results Ten patients were identified with BiBPPV. Most patients complained of nonlocalized positional vertigo and unsteadiness. Four were males and 6 were females, and the mean age was 54 years. There was a positive history of recent head trauma in 4 of the patients. All patients recovered after performing a mean of 2.6 EMs during a 3-month period. One patient experienced unilateral recurrence and was re-treated successfully. Conclusion BiBPPV has typical characteristics and can be managed successfully with EM, performed on the more symptomatic side, followed by repeated treatments as needed. Ebm Rating: C © 2005 American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc. All rights reserved.
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Affiliation(s)
- Daniel M Kaplan
- Department of Otolaryngology-Head and Neck Surgery, Soroka University Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel.
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Carneiro de Sousa PJM, Abreu Pereira DM, Carneiro Melo Pereira de Magalhães P, Duarte DRDS, Trigueiros da Silva Cunha NM. Vitamin D deficiency and benign paroxysmal positioning vertigo. HEARING BALANCE AND COMMUNICATION 2019. [DOI: 10.1080/21695717.2019.1590988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Diogo Manuel Abreu Pereira
- Otorhinolaryngology Department, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Porto, Portugal
| | | | - Delfim Rui da Silva Duarte
- Otorhinolaryngology Department, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Porto, Portugal
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Association between bone mineral density and benign paroxysmal positional vertigo: a meta-analysis. Eur Arch Otorhinolaryngol 2019; 276:1561-1571. [DOI: 10.1007/s00405-019-05345-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/12/2019] [Indexed: 12/22/2022]
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Hsu CL, Tsai SJ, Shen CC, Lu T, Hung YM, Hu LY. Risk of benign paroxysmal positional vertigo in patients with depressive disorders: a nationwide population-based cohort study. BMJ Open 2019; 9:e026936. [PMID: 30928959 PMCID: PMC6475146 DOI: 10.1136/bmjopen-2018-026936] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The association between depression and benign paroxysmal positional vertigo (BPPV) remains debated. This study aimed to investigate the risk of BPPV in patients with depressive disorders. DESIGN Longitudinal nationwide cohort study. SETTING National health insurance research database in Taiwan. PARTICIPANTS We enrolled 10 297 patients diagnosed with depressive disorders between 2000 and 2009 and compared them to 41 188 selected control patients who had never been diagnosed with depressive disorders (at a 1:4 ratio matched by age, sex and index date) in relation to the risk of developing BPPV. METHODS The follow-up period was defined as the time from the initial diagnosis of depressive disorders to the date of BPPV, censoring or 31 December 2009. Cox proportional hazard regression analysis was used to investigate the risk of BPPV by sex, age and comorbidities, with HRs and 95% CIs. RESULTS During the 9-year follow-up period, 44 (0.59 per 1000 person-years) patients with depressive disorders and 99 (0.33 per 1000 person-years) control patients were diagnosed with BPPV. The incidence rate ratio of BPPV among both cohorts calculating from events of BPPV per 1000 person-years of observation time was 1.79 (95% CI 1.23 to 2.58, p=0.002). Following adjustments for age, sex and comorbidities, patients with depressive disorders were 1.55 times more likely to develop BPPV (95% CI 1.08 to 2.23, p=0.019) as compared with control patients. In addition, hyperthyroidism (HR=3.75, 95% CI 1.67-8.42, p=0.001) and systemic lupus erythematosus (SLE) (HR=3.47, 95% CI 1.07 to 11.22, p=0.038) were potential risk factors for developing BPPV in patients with depressive disorders. CONCLUSIONS Patients with depressive disorders may have an increased risk of developing BPPV, especially those who have hyperthyroidism and SLE.
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Affiliation(s)
- Chiao-Lin Hsu
- Department of Health Management Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Nursing, Meiho University, Pingtung, Taiwan
- Department of Medical Education and Research and Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shih-Jen Tsai
- Top Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Che Shen
- Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Psychiatry, Taichung Veterans General Hospital Chiayi Branch, Chiayi, Taiwan
| | - Ti Lu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yao-Min Hung
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Yu Hu
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Top Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Social Work, Soochow University, Taipei, Taiwan
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Byun H, Chung JH, Lee SH, Park CW, Kim EM, Kim I. Increased risk of benign paroxysmal positional vertigo in osteoporosis: a nationwide population-based cohort study. Sci Rep 2019; 9:3469. [PMID: 30837524 PMCID: PMC6401187 DOI: 10.1038/s41598-019-39830-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/31/2019] [Indexed: 12/14/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo, which results from dislodged vestibular otoliths. Because the otoliths are mainly composed of calcium carbonate, it has been suggested that BPPV may be associated with osteoporosis. We aimed to assess the incidence and recurrence of BPPV in osteoporosis patients using a nationwide population-based cohort study with matched control. We used the database of the National Health Insurance Service of Korea, a universal system covering all 50 million Koreans. Osteoporosis was defined as patients who underwent bone mineral density tests and visited a clinic three or more times between Jan 2004 and Dec 2006. A control cohort consisted of non-osteoporotic subjects socio-demographically matched in a ratio of 1:1. The incidence and recurrence of BPPV between Jan 2007 and Dec 2016 were evaluated. A total of 177,797 osteoporosis patients and the same number of matched controls were identified. The incidence rates (IR) of BPPV in the osteoporosis patients and controls were 31.58 and 18.09 per 1000 persons, respectively (ratio of IR, IRR = 1.75, 95% CI 1.67–1.83). The IRs of recurrent BPPV were 187.3/1000 in the osteoporosis, 163.5/1000 in the controls (IRR = 1.15, 95% CI 1.02–1.28). In multivariate analysis, osteoporosis, female gender (adjusted HR = 1.76), age <65 (adjusted HR = 0.8), living in a metropolis, earning more than the lowest income and hypertension were significantly associated with increased risk of BPPV development. For recurrence, osteoporosis was the only meaningful risk factor (adjusted HR = 1.12). In conclusion, the risks of BPPV development and recurrence are higher in osteoporosis. Physicians might consider informing osteoporosis patients of the risk of developing BPPV and related falls.
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Affiliation(s)
- Hayoung Byun
- Department of Otolaryngology, Hanyang University, Seoul, Korea
| | - Jae Ho Chung
- Department of Otolaryngology, Hanyang University, Seoul, Korea.
| | - Seung Hwan Lee
- Department of Otolaryngology, Hanyang University, Seoul, Korea
| | - Chul Won Park
- Department of Otolaryngology, Hanyang University, Seoul, Korea
| | - Eun Mi Kim
- Department of Health Sciences, Hanyang University Graduate School, Seoul, Korea
| | - Inah Kim
- Department of Occupational and Environmental Medicine, Hanyang University, Seoul, Korea
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Rhim GI. Serum Vitamin D and Long-term Outcomes of Benign Paroxysmal Positional Vertigo. Clin Exp Otorhinolaryngol 2019; 12:273-278. [PMID: 30813712 PMCID: PMC6635707 DOI: 10.21053/ceo.2018.00381] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 11/21/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The purpose of the present study was to examine the effect of serum vitamin D concentrations on the longterm recurrence rates of benign paroxysmal positional vertigo (BPPV) patients. METHODS The present study was conducted with patients diagnosed with BPPV from June 2014 to April 2016. Whether the patients' sex, age, types and locations of semicircular canals, diabetes, hypertension, hyperlipidemia, and vitamin D concentrations affect their recurrence rates was examined using Pearson chi-square tests, independent samples t-tests and Cox proportional hazards regression analyses. The effects of vitamin D concentrations on long-term recurrence rates were examined using Kaplan-Meier estimates and log-rank tests. RESULTS The recurrence rates obtained with Kaplan-Meier estimates were 18% and 50% at 12 months and 24 months, respectively. When the patients were divided into groups with vitamin D concentrations of <10 ng/mL and ≥10 ng/mL and the recurrence rates of the groups were compared, the difference was statistically significant (P=0.040). In addition, when the patients were divided into groups with vitamin D concentrations of <15 ng/mL and ≥15 ng/mL and the recurrence rates of the groups were compared, the difference was statistically quite significant (P=0.017). In a Cox regression model, variables such as age, sex, the types and locations of semicircular canals, hypertension, diabetes, hyperlipidemia, and 25-hydroxy vitamin D did not significantly affect recurrence. CONCLUSION The present study investigated the recurrence rates of BPPV in patients for a long time without limiting the sex, age, or locations of semicircular canals and it could be seen that serum vitamin D concentrations significantly affected the recurrence of BPPV.
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Affiliation(s)
- Gu Il Rhim
- One Otorhinolaryngology Clinic, Paju, Korea
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Yang X, Yang B, Wu M, Wang F, Huang X, Li K, Mao Z, Xu Z, Ren H. Association Between Serum Uric Acid Levels and Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-Analysis of Observational Studies. Front Neurol 2019; 10:91. [PMID: 30828314 PMCID: PMC6385523 DOI: 10.3389/fneur.2019.00091] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 01/23/2019] [Indexed: 12/20/2022] Open
Abstract
Objective: The objective of the present study was to meta-analyze relevant literature to gain a comprehensive understanding of the potential relationship between serum uric acid levels and risk of benign paroxysmal positional vertigo (BPPV). Methods: The databases of PubMed, Web of Science, Embase, Chinese National Knowledge Infrastructure, Wanfang, and SinoMed were systematically searched for observational case-control studies of the association between BPPV and serum uric acid levels published up to October 2018. Data from eligible studies were meta-analyzed using Stata 12.0. Results: A total of 12 studies were included in the analysis. There was a strong tendency for serum uric acid levels to be associated with risk of BPPV among studies conducted in China (OR 0.69, 95%CI 0.01–1.40, p = 0.053), but not among studies outside China (OR 1.07, 95%CI 1.08–3.22, p = 0.33). Across all studies, serum uric acid level was significantly higher among individuals with BPPV than among controls (OR 0.78, 95%CI 0.15–1.41, p = 0.015), yet it did not independently predict risk of the disorder (OR 1.003, 95%CI 0.995–1.012, p = 0.471). Conclusion: The available evidence suggests that BPPV is associated with elevated levels of serum uric acid, but these levels may not be an independent risk factor of BPPV.
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Affiliation(s)
- Xinglong Yang
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Baiyuan Yang
- Department of Neurology, Seventh People's Hospital of Chengdu, Chengdu, China
| | - Mengjun Wu
- Department of Anesthesiology, Chengdu Women and Children's Central Hospital, Chengdu, China
| | - Fang Wang
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaodong Huang
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Kelu Li
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhiwei Mao
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhong Xu
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hui Ren
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
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Abstract
The world's population is ageing due to increased hygiene and improved medical care. Dizziness and imbalance frequently affect the elderly and is most common among individuals over the age of 60. In this age group approximately 30% of the population experience these debilitating symptoms at some point. They contribute to falls and frailty, which often result in hospitalization causing tremendous cost for the health care systems, and increased mortality. To make the matters worse balance disorders are often complex. Physicians face the difficulty of diagnosing the patient with the exact disorder especially since each disorder may manifest differently in each patient. In addition, several treatment options exist, however, with a low level of evidence. This chapter summarizes the underlying degenerative processes of the peripheral as well as the central vestibular system, diagnostic tools, the most common balance disorders in the elderly, and possible treatment options of these disorders.
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Choi HG, Lee JK, Kong IG, Lim H, Kim SY. Osteoporosis increases the risk of benign paroxysmal positional vertigo: a nested case-control study using a national sample cohort. Eur Arch Otorhinolaryngol 2018; 276:335-342. [PMID: 30511104 DOI: 10.1007/s00405-018-5230-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 11/28/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The previous studies suggested an association between osteoporosis and sudden sensory neural hearing loss (SSNHL). The aim of the present study was to evaluate the association between osteoporosis and benign paroxysmal positional vertigo (BPPV). MATERIALS AND METHODS Data from the Korean National Health Insurance Service-National Sample Cohort of participants who were ≥ 50 years old were collected from 2002 to 2013. A total of 13,484 BPPV participants were matched with respect to age group, sex, income group, region of residence, hypertension, diabetes, and dyslipidemia to 53,936 controls. In both the BPPV and control groups, the previous histories of osteoporosis were evaluated. Crude (simple) and adjusted odds ratios (ORs) of osteoporosis for BPPV were analyzed using unconditional logistic regression analyses. Subgroup analyses were conducted according to age, sex, and BPPV frequency. RESULTS A total of 18.64% (2514/13,464) of the BPPV group and 12.21% (6589/53,936) of the control group had a history of osteoporosis (P < 0.001). The adjusted OR of osteoporosis for BPPV was 1.29 (95% CI = 1.23-1.35, P < 0.001). In the subgroup analysis according to age and sex, the ≥ 70-year-old men did not demonstrate a high adjusted OR of osteoporosis for BPPV. All other age and sex subgroups demonstrated high adjusted ORs of osteoporosis for BPPV. CONCLUSIONS Osteoporosis increased the risk of BPPV in the population aged ≥ 50 years. The OR of osteoporosis was higher in the frequent BPPV group than in the less frequent BPPV group.
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Affiliation(s)
- Hyo Geun Choi
- Department of Internal Medicine, Hallym University College of Medicine, Anyang, South Korea
| | - Joon Kyu Lee
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Il Gyu Kong
- Department of Internal Medicine, Hallym University College of Medicine, Anyang, South Korea
| | - Hyun Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Anyang, South Korea
| | - So Young Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University College of Medicine, 59, Yatap-ro, Bundang-gu, Seongnam, Gyeonggi-do, 13496, South Korea.
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Fujimoto C, Kawahara T, Kinoshita M, Kikkawa YS, Sugasawa K, Yagi M, Yamasoba T, Iwasaki S, Murofushi T. Aging Is a Risk Factor for Utricular Dysfunction in Idiopathic Benign Paroxysmal Positional Vertigo. Front Neurol 2018; 9:1049. [PMID: 30559714 PMCID: PMC6287371 DOI: 10.3389/fneur.2018.01049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 11/19/2018] [Indexed: 11/13/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) is the most common cause of balance disorders in the elderly. Dislodgement of the otoconia in BPPV might have an association with damage to the otolith organs. The aim of this study was to investigate whether aging is a risk factor for otolith organ dysfunction in idiopathic BPPV. We retrospectively reviewed the medical records of 112 consecutive idiopathic BPPV patients who underwent cervical VEMP testing to air-conducted sound (ACS cVEMP), ocular VEMP testing to bone-conducted vibration (BCV oVEMP), and caloric testing. We performed binomial logistic regression analyses to see whether age, the side affected by BPPV or the canal affected by BPPV have an association with the presence of peripheral vestibular dysfunction in idiopathic BPPV patients. The elderly group (aged ≥65 years) had a significantly positive association with abnormalities in BCV oVEMPs (p = 0.0109), while the side affected by BPPV (p = 0.598) and the canal affected by BPPV (p = 0.576) did not. The odds ratio of the abnormal BCV oVEMPs for the elderly group compared with the non-elderly group (aged < 65 years) was 2.676 (95% confidence interval, 1.254–5.079). The elderly group had no significant association with the abnormalities in ACS cVEMPs (p = 0.0955) or caloric testing (p = 0.488). Dysfunction of the utricle, where the dislodgement of the otoconia mainly occurs, is affected by aging in idiopathic BPPV.
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Affiliation(s)
- Chisato Fujimoto
- Department of Otolaryngology, Tokyo Teishin Hospital, Tokyo, Japan.,Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Takuya Kawahara
- Biostatistics Division, Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Makoto Kinoshita
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yayoi S Kikkawa
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Keiko Sugasawa
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masato Yagi
- Department of Otolaryngology, Tokyo Teishin Hospital, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Shinichi Iwasaki
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Toshihisa Murofushi
- Department of Otolaryngology, Tokyo Teishin Hospital, Tokyo, Japan.,Department of Otolaryngology, School of Medicine, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
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Bruintjes TD, van der Zaag-Loonen HJ, Eggelmeijer F, van Leeuwen RB. The prevalence of benign paroxysmal positional vertigo in patients with osteoporosis. Eur Arch Otorhinolaryngol 2018; 275:3083-3086. [DOI: 10.1007/s00405-018-5164-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/09/2018] [Indexed: 11/24/2022]
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Bayram A. The Role Of Vitamin D In Otolaryngological Diseases: Myth Or Truth. ENT UPDATES 2018. [DOI: 10.32448/entupdates.459029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Maslovara S, Butkovic Soldo S, Sestak A, Milinkovic K, Rogic-Namacinski J, Soldo A. 25 (OH) D3 levels, incidence and recurrence of different clinical forms of benig paroxysmal positional vertigo. Braz J Otorhinolaryngol 2018; 84:453-459. [PMID: 28655524 PMCID: PMC9449225 DOI: 10.1016/j.bjorl.2017.05.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/19/2017] [Accepted: 05/22/2017] [Indexed: 11/27/2022] Open
Abstract
Introduction Objectives Methods Results Conclusions
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Recurrence in Benign Paroxysmal Positional Vertigo: A Large, Single-Institution Study. Otol Neurotol 2018; 39:622-627. [DOI: 10.1097/mao.0000000000001800] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wei W, Sayyid ZN, Ma X, Wang T, Dong Y. Presence of Anxiety and Depression Symptoms Affects the First Time Treatment Efficacy and Recurrence of Benign Paroxysmal Positional Vertigo. Front Neurol 2018; 9:178. [PMID: 29619005 PMCID: PMC5871662 DOI: 10.3389/fneur.2018.00178] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 03/07/2018] [Indexed: 01/30/2023] Open
Abstract
Objectives To investigate the possible effects of anxiety and/or depression symptoms on the treatment outcomes and recurrence of benign paroxysmal positional vertigo (BPPV). Methods This is a retrospective study conducted at a single institution. 142 consecutive patients diagnosed with idiopathic BPPV at the Department of Otology in Shengjing Hospital of China Medical University between October 2016 and July 2017 were retrospectively reviewed. 127 patients were finally included in this study. Zung self-rating anxiety scale (SAS) and Zung self-rating depression scale (SDS) were used to evaluate the presence of anxiety and/or depression, respectively, in our BPPV patients. A significant score (at or above 50 for SAS and 53 for SDS) represents the presence of clinically significant symptoms. Two-tailed Student’s t-test, χ2 test, and logistic regression analysis were used as appropriate. A p value less than 0.05 was considered statistically significant. Results The prevalence of anxiety and/or depression symptoms in BPPV patients in the present study was 49.61%. The effectiveness of the first time canalith repositioning maneuver (CRM) was 70.08%. With weekly follow-up treatments of CRM, the success rate increased to 97.64% by 1 month. The total recurrence rate at 6-month follow-up post-cure was 14.17%. Holding all other variables constant, patients with psychiatric symptoms (Relative-risk ratio: 3.160; p = 0.027) and patients with non-posterior semicircular canal (PSC) involvement (Relative-risk ratio: 7.828, p = 0.013) were more likely to experience residual dizziness (RD) even after effective CRM treatment. Psychiatric symptoms (Relative-risk ratio: 6.543; p = 0.001) and female gender (Relative-risk ratio: 4.563; p = 0.010) are risk factors for the failure of first time CRM. In addition, BPPV patients with psychiatric symptoms (Odds ratio: 9.184, p = 0.008) were significantly more likely to experience recurrences within the first 6 months after a successful maneuver. Conclusion Anxiety-depression status significantly reduced the efficacy of the first time CRM and increased the risk for recurrence. Other factors, such as female gender and non-PSC involvement are also susceptible risk factors for BPPV patients to require multiple treatments and experience delayed recovery. A screening for psychiatric symptoms in BPPV patients and active treatment of these symptoms would benefit both physicians and patients in understanding and improving the prognosis of the disease and treatment options.
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Affiliation(s)
- Wei Wei
- Department of Otology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zahra N Sayyid
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Xiulan Ma
- Department of Otology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tian Wang
- Department of Otolaryngology-Head and Neck Surgery, Second Xiangya Hospital of Central South University, Changsha, China
| | - Yaodong Dong
- Department of Otology, Shengjing Hospital of China Medical University, Shenyang, China
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Abstract
OBJECTIVE To test the hypothesis that age-related demineralization of otoconia will result in an age-related increase in blood levels of otoconia matrix protein, otolin-1. STUDY DESIGN Cross-sectional observational clinical trial. SETTING Clinical research center. PATIENTS Seventy nine men and women ranging in age from 22 to 95 years old. INTERVENTIONS Diagnostic. MAIN OUTCOME MEASURES Blood levels of otolin-1 in relation to age. RESULTS Levels of otolin-1 of subjects divided into four age groups (1: 20-30 [n = 20], 2: 50-65 [n = 20], 3: 66-80 [n = 20], 4: 81-95 [n = 19] years old) demonstrated an increasing trend with age. The difference between otolin levels of groups 2 and 3, as well as, (p = 0.04) and 2 and 4 (p = 0.031) were statistically significant, but there was no significant difference between the two oldest groups. CONCLUSIONS Otolin-1 blood levels are significantly higher in patients older than 65 years of age. This is consistent with previous scanning electron microscopy findings of age-related otoconia degeneration and increased prevalence of benign paroxysmal positional vertigo (BPPV) with age. Normative data provided here can serve as important reference values against which levels from BPPV patients can be compared with further evaluate otolin-1 as a circulatory biomarker for otoconia degeneration.
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Yang CJ, Kim Y, Lee HS, Park HJ. Bone mineral density and serum 25-hydroxyvitamin D in patients with idiopathic benign paroxysmal positional vertigo. J Vestib Res 2018; 27:287-294. [DOI: 10.3233/ves-170625] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Chan Joo Yang
- Department of Otolaryngology, Hanil General Hospital, Seoul, Republic of Korea
| | - Yehree Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hwan Seo Lee
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hong Ju Park
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Wu Y, Gu C, Han W, Lu X, Chen C, Fan Z. Reduction of bone mineral density in native Chinese female idiopathic benign paroxysmal positional vertigo patients. Am J Otolaryngol 2018; 39:31-33. [PMID: 29042068 DOI: 10.1016/j.amjoto.2017.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/11/2017] [Accepted: 09/18/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study aimed to investigate the clinical association between idiopathic benign paroxysmal positional vertigo (BPPV) and reduction of bone mineral density (BMD). METHODS BMD was measured in 78 native Chinese female de novo idiopathic BPPV patients and 126 healthy controls using dual-energy X-ray absorptiometry. We compared the mean T-scores and abnormal BMD prevalence between the two groups. RESULTS The mean T-scores were significantly lower in idiopathic BPPV patients than in healthy controls. The prevalence of osteopenia and osteoporosis were significantly higher in idiopathic BPPV patients than in healthy controls (65.4% vs 48.4%, p=0.013). CONCLUSION BMD reduction may be associated with idiopathic BPPV occurrence.
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Calcium Homeostasis During Attack and Remission in Patients With Idiopathic Benign Paroxysmal Positional Vertigo. Otol Neurotol 2017; 37:1388-92. [PMID: 27525708 DOI: 10.1097/mao.0000000000001167] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate changes in calcium metabolism in patients with idiopathic benign paroxysmal positional vertigo (BPPV) on initial presentation and at the follow-up visit. SUBJECTS AND METHODS The study comprised a total of 31 patients aged greater than 18 years who presented at the otorhinolaryngology outpatient clinic of our hospital, newly diagnosed as idiopathic BPPV based on the history compatible with BPPV and positive provocative maneuver (either Dix-Hallpike or Roll test). The first blood sample was obtained on the day of initial presentation when the patient was found to have active unilateral BPPV. After 6 months, a blood sample was again drawn in accordance with the procedure. Blood samples were analyzed for data on 25-hydroxyvitamin D (25(OH)-D), total calcium, parathormone and ionized calcium on initial presentation, and at the follow-up visit. RESULTS The patients comprised 20 (64.5%) women and 11 (35.5%) men with a mean age of 49.78 years (range, 23-75 years). During an attack a higher prevalence of decreased serum Vitamin D is less than 20 ng/ml, was determined (93.5% versus 38.7%). There were statistical differences between the Vitamin D values, parathormone, and corrected by pH ionized calcium in both periods (p < 0.05). CONCLUSION A statistically significant association was determined between Vitamin D and calcium metabolism in patients with idiopathic BPPV. It can be considered that Vitamin D deficiency and decreased ionized Ca level may be a risk for BPPV, not only in patients with osteoporosis but also in all patients. Very low levels of 25(OH)-D seem to be associated with recurrence of BPPV. The recurrences might possibly be prevented with supplementary Vitamin D especially in those with recurrent idiopathic BPPV but further studies would be necessary to determine this.
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Ichijo H, Akita M. Gender difference and laterality of sleep position. Auris Nasus Larynx 2017; 45:592-597. [PMID: 28863980 DOI: 10.1016/j.anl.2017.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/26/2017] [Accepted: 08/09/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A higher incidence in women (approximately 7:3) and a predominant involvement of the right ear (approximately 7:5) are interesting features of BPPV (benign paroxysmal positional vertigo). It is speculated that these features are related to sleep position. The first aim of this study was to compare the frequency of position shifts during sleep between men and women. The second aim was to elucidate any differences in sleep position between men and women. The third aim was to clarify the laterality of sleep position. METHODS We retrospectively selected the data of 30 males (mean, 53.1 years) and 22 females (mean, 50.6 years) diagnosed as mild or moderate obstructive sleep apnea. A position sensor was attached to the patient's anterior chest. Supine position was defined as less than 45° tilt, and lateral position was defined as more than 45° tilt. A single overnight laboratory polysomnography provided the number of position shifts, total sleep time, sleep time spent in the supine position (S), sleep time spent in the right-side-down lateral position (R), and sleep time spent in the left-side-down lateral position (L). RESULTS The mean value and standard deviation of the number of position shifts per hour was 2.4±1.3 in males, and 2.3±1.1 in females. There was no significant difference between males and females. Twelve cases (40%) were lateral type (S<R+L), and 18 (60%) were supine type (S>R+L) in males. Ten cases (45%) were lateral type, and 12 (55%) were supine type in females. There was no significant difference between males and females. Seventeen cases (56.6%) were right-dominant type (R-L>0), and 13 (43.3%) were left-dominant type (R-L<0) in males. Thirteen cases (59%) were right-dominant type, and 9 (41%) were left-dominant type in females. CONCLUSION Body position and the number of position shifts during sleep differ substantially between individuals. There is no gender difference in the frequency of position shifts. Although the supine type is more common than the lateral type, there is no gender difference in sleep position. Therefore, the reason of higher incidence in women is not related to sleep. The right-dominant type occurs more than the left-dominant type in both genders. It is possible that this behavior is the reason for the predominant involvement of the right ear in BPPV.
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Affiliation(s)
- Hiroaki Ichijo
- Ichijo Ear, Nose and Throat Clinic, 3-2-1, Ekimae, Hirosaki 036-8002, Japan.
| | - Miwaoki Akita
- Yoshida Ear, Nose and Throat Clinic, 2-1-15, Nakano, Hirosaki 036-8155, Japan.
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Yang H, Gu H, Sun W, Li Y, Wu H, Burnee M, Zhuang J. Estradiol deficiency is a risk factor for idiopathic benign paroxysmal positional vertigo in postmenopausal female patients. Laryngoscope 2017; 128:948-953. [PMID: 28480516 DOI: 10.1002/lary.26628] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/16/2017] [Accepted: 03/20/2017] [Indexed: 01/11/2023]
Abstract
OBJECTIVES/HYPOTHESIS Although it is generally considered that benign paroxysmal positional vertigo (BPPV) is associated with changes in female sex hormone levels, no direct data have been reported until now. The purpose of this article was to provide direct data showing the distinct relationship between female sex hormone fluctuations and BPPV in postmenopausal female patients. STUDY DESIGN Prospective analysis in humans and basic research in animals. METHODS Blood samples were analyzed to determine the levels of estradiol, progesterone, follicle-stimulating hormone, and luteinizing hormone in 50- to 80-year-old postmenopausal female patients newly diagnosed with idiopathic BPPV based on history compatible with BPPV and positive provocative maneuvers. Animal models of bilateral ovariectomy and female sex hormone replacement therapy were used to further confirm the relationship between BPPV and female sex hormone levels by determining the expression levels of otoconin 90, the protein suggested as essential in the dislocation of otoconia. RESULTS Statistically significant differences between the estradiol level of BPPV patients and the control group were found (P < .001). Moreover, in bilateral ovariectomy in rats, 17β-estradiol replacement reversed the decrease of otoconin 90 levels. CONCLUSIONS Our results suggest that estradiol deficiency may be an important risk factor for idiopathic benign paroxysmal positional vertigo in postmenopausal female patients. LEVEL OF EVIDENCE NA. Laryngoscope, 128:948-953, 2018.
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Affiliation(s)
- Hualan Yang
- Department of Neurology, Medical Center for Vertigo and Balance Disorders, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Huanhuan Gu
- Department of Neurology, Medical Center for Vertigo and Balance Disorders, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Wenjing Sun
- Department of Neurology, Medical Center for Vertigo and Balance Disorders, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yanpeng Li
- Department of Neurology, Medical Center for Vertigo and Balance Disorders, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Huijuan Wu
- Department of Neurology, Medical Center for Vertigo and Balance Disorders, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Molorerdene Burnee
- Department of Neurology, Medical Center for Vertigo and Balance Disorders, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jianhua Zhuang
- Department of Neurology, Medical Center for Vertigo and Balance Disorders, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Lee SB, Lee CH, Kim YJ, Kim HM. Biochemical markers of bone turnover in benign paroxysmal positional vertigo. PLoS One 2017; 12:e0176011. [PMID: 28467451 PMCID: PMC5415135 DOI: 10.1371/journal.pone.0176011] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 04/03/2017] [Indexed: 01/19/2023] Open
Abstract
Objective Several studies have suggested a possible relationship between recurrent benign paroxysmal positional vertigo (BPPV) and altered calcium homeostasis in the endolymph of the inner ear. The present study aimed to evaluate the association between Ca2+ and vitamin D status and BPPV occurrence as well as the status of bone biochemical markers in osteoporotic patients who were diagnosed with idiopathic BPPV. Methods The study included total 132 patients who were referred to our clinic between August 2008 and October 2013. Based on the bone mineral density (BMD) results, the subjects were divided into three groups: normal BMD (n = 34), osteopenia (n = 40) and osteoporosis (n = 58). The biochemical markers of bone turnover including serum Carboxy-terminal telopeptide of type I collagen (s-CTX), osteocalcin, alkaline phosphatase (ALP) and urinary free deoxypyridinoline (u-DPD), were analyzed, along with the serum Ca2+ and vitamin D levels. Results The mean serum calcium, phosphate and creatinine clearance levels were within the standard laboratory reference range. The incidence of vitamin D deficiency was 11.8% (4/34) in the normal BMD group, 15% (6/40) in the osteopenia group and 43.1% (25/58) in the osteoporosis group. There was a positive correlation between the 25(OH)D and BMD results in the patients with BPPV. Among the bone turnover markers, the osteocalcin and u-DPD levels were significantly elevated in the osteoporotic patients with BPPV. Multiple logistic regression analyses showed that osteoporosis and vitamin D deficiency were associated with BPPV. Conclusion Our findings suggest that the prevalence of BPPV in osteoporotic patients is associated with vitamin D deficiency and high bone turnover rates at systemic level, which could disturb local Ca2+ homeostasis in the inner ear.
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Affiliation(s)
- Sun Bin Lee
- Otorhinolaryngology Department, CHA University, Seongnam, Korea
| | - Chang Ho Lee
- Otorhinolaryngology Department, CHA University, Seongnam, Korea
| | - Young Ju Kim
- Otorhinolaryngology Department, CHA University, Seongnam, Korea
| | - Hyoung-Mi Kim
- Otorhinolaryngology Department, CHA University, Seongnam, Korea
- * E-mail:
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D'Silva LJ, Staecker H, Lin J, Sykes KJ, Phadnis MA, McMahon TM, Connolly D, Sabus CH, Whitney SL, Kluding PM. Retrospective data suggests that the higher prevalence of benign paroxysmal positional vertigo in individuals with type 2 diabetes is mediated by hypertension. J Vestib Res 2016; 25:233-9. [PMID: 26890424 DOI: 10.3233/ves-150563] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Benign Paroxysmal Positional Vertigo (BPPV) has been linked to comorbidities like diabetes and hypertension. However, the relationship between type 2 diabetes (DM) and BPPV is unclear. The purpose of this retrospective study was to examine the relationship between DM and BPPV in the presence of known contributors like age, gender and hypertension. METHODS A retrospective review of the records of 3933 individuals was categorized by the specific vestibular diagnosis and for the presence of type 2 DM and hypertension. As the prevalence of BPPV was higher in people with type 2 DM compared to those without DM, multivariable logistic regressions were used to identify variables predictive of BPPV. The relationship between type 2 DM, hypertension and BPPV was analyzed using mediation analysis. RESULTS BPPV was seen in 46% of individuals with type 2 DM, compared to 37% of individuals without DM (p< 0.001). Forty two percent of the association between type 2 DM and BPPV was mediated by hypertension, and supported hypertension as a complete mediator in the relationship between type 2 DM and BPPV. CONCLUSIONS Hypertension may provide the mediating pathway by which diabetes affects the vestibular system. Individuals with complaints of dizziness, with comorbidities including hypertension and diabetes, may benefit from a screening for BPPV.
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Affiliation(s)
- Linda J D'Silva
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Hinrich Staecker
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - James Lin
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kevin J Sykes
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Milind A Phadnis
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Tamara M McMahon
- Division of Medical Informatics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Dan Connolly
- Division of Medical Informatics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Carla H Sabus
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Susan L Whitney
- University of Pittsburgh, School of Health and Rehabilitation Sciences, Pittsburg, PA, USA.,Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Patricia M Kluding
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
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Zuma e Maia F. New Treatment Strategy for Apogeotropic Horizontal Canal Benign Paroxysmal Positional Vertigo. Audiol Res 2016; 6:163. [PMID: 27942374 PMCID: PMC5134676 DOI: 10.4081/audiores.2016.163] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 09/29/2016] [Accepted: 09/29/2016] [Indexed: 11/22/2022] Open
Abstract
The apogeotropic variant of horizontal semicircular canal benign paroxysmal positional vertigo (HC-BPPV) is attributed to canalithiasis of the anterior arm or cupulolithiasis. Despite some therapeutic maneuvers, I propose a new treatment strategy for apogeotropic HC-BPPV that is designed to detach both the otoconial debris from the anterior arm of the semicircular canal and the debris that is attached to the utricular side of the cupula using inertia and gravity and based on simulations with a 3D biomechanical model.
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Rhim GI. Serum vitamin D and recurrent benign paroxysmal positional vertigo. Laryngoscope Investig Otolaryngol 2016; 1:150-153. [PMID: 28894811 PMCID: PMC5510269 DOI: 10.1002/lio2.35] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/14/2016] [Accepted: 09/16/2016] [Indexed: 02/06/2023] Open
Abstract
Objectives The objective of the present study was to examine the effects of serum 25‐hydroxyvitamin D concentrations on patients diagnosed with benign paroxysmal positional vertigo (BPPV) on BPPV recurrence. Study Design Case series. Methods A retrospective review of 232 patients diagnosed with BPPV visiting the clinic between June 2014 and June 2015 was performed. All patients underwent a complete otolaryngological, audiologic, and neurologic evaluation. The appropriate particle‐repositioning maneuver was performed depending on the type of BPPV. The patients were divided into the recurrence group and the nonrecurrence group. Age, gender, follow‐up period, type of BPPV, and vitamin D concentrations in the two groups were compared and analyzed through binary logistic regression analyses. Results The average follow‐up period after treatment was 10.2 months. Forty‐one (17.7%) of 232 patients suffered a recurrence during the follow‐up period. The mean vitamin D concentration of 191 patients who did not suffer any recurrence was 16.63 ng/mL, whereas that of 41 patients who suffered a recurrence was 13.64 ng/mL. This difference in vitamin D concentrations was statistically significant (P < 0.019). The patients' age, gender, follow‐up period, and type of BPPV had no statistically significant impact. Conclusion Vitamin D is assumed to affect BPPV as a recurrence factor independent of age, gender, follow‐up period, and type of BPPV. Level of Evidence 4.
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Affiliation(s)
- Gu Il Rhim
- Yonseimirae Otorhinolaryngology Clinic (g.i.r.) Paju Republic of Korea
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79
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Association Between Osteoporosis/Osteopenia and Vestibular Dysfunction in South Korean Adults. Ear Hear 2016; 37:615-9. [PMID: 27232074 DOI: 10.1097/aud.0000000000000320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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80
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Preliminary Report on the Investigation of the Association Between BPPV and Osteoporosis Using Biomarkers. Otol Neurotol 2016; 36:1532-6. [PMID: 26375977 DOI: 10.1097/mao.0000000000000853] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To test the hypothesis that levels of a BPPV biomarker, otolin-1, correlate with those of osteoporosis markers, aminoterminal propeptide of protocollagen type I (P1NP), and aminoterminal telopeptides of collagen (NTX), thus further supporting a link between the two diseases. STUDY DESIGN Prospective pilot clinical trial (Level of Evidence: 2b). PATIENTS Postmenopausal women with BPPV. INTERVENTIONS Diagnostic. MAIN OUTCOME MEASURES Serum levels of otolin-1, P1NP, NTX, vitamin D, and calcium were examined in relation to each other, age, and DEXA scan T-scores. RESULTS There was a strong, negative correlation between T-scores and otolin-1 levels. Although P1NP and NTX levels were strongly correlated, neither had statistical correlations with otolin-1. CONCLUSIONS Despite a strong correlation between DEXA scan results and otolin-1 levels, there were no significant correlations between otolin-1 and P1NP or NTX. This suggests that the association between osteoporosis and BPPV is complex, but not likely to be causal. Although more work is needed to elucidate these relationships, this preliminary finding has important practical implications for BPPV in that proactive management of osteoporosis, per se, would not be expected to have benefits in management of BPPV.
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81
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Chang TP, Lin YW, Sung PY, Chuang HY, Chung HY, Liao WL. Benign Paroxysmal Positional Vertigo after Dental Procedures: A Population-Based Case-Control Study. PLoS One 2016; 11:e0153092. [PMID: 27044009 PMCID: PMC4820237 DOI: 10.1371/journal.pone.0153092] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/23/2016] [Indexed: 11/18/2022] Open
Abstract
Background Benign paroxysmal positional vertigo (BPPV), the most common type of vertigo in the general population, is thought to be caused by dislodgement of otoliths from otolithic organs into the semicircular canals. In most cases, however, the cause behind the otolith dislodgement is unknown. Dental procedures, one of the most common medical treatments, are considered to be a possible cause of BPPV, although this has yet to be proven. This study is the first nationwide population-based case-control study conducted to investigate the correlation between BPPV and dental manipulation. Methods Patients diagnosed with BPPV between January 1, 2007 and December 31, 2012 were recruited from the National Health Insurance Research Database in Taiwan. We further identified those who had undergone dental procedures within 1 month and within 3 months before the first diagnosis date of BPPV. We also identified the comorbidities of the patients with BPPV, including head trauma, osteoporosis, migraine, hypertension, diabetes, hyperlipidemia and stroke. These variables were then compared to those in age- and gender-matched controls. Results In total, 768 patients with BPPV and 1536 age- and gender-matched controls were recruited. In the BPPV group, 9.2% of the patients had undergone dental procedures within 1 month before the diagnosis of BPPV. In contrast, only 5.5% of the controls had undergone dental treatment within 1 month before the date at which they were identified (P = 0.001). After adjustments for demographic factors and comorbidities, recent exposure to dental procedures was positively associated with BPPV (adjusted odds ratio 1.77; 95% confidence interval 1.27–2.47). This association was still significant if we expanded the time period from 1 month to 3 months (adjusted odds ratio 1.77; 95% confidence interval 1.39–2.26). Conclusions Our results demonstrated a correlation between dental procedures and BPPV. The specialists who treat patients with BPPV should consider dental procedures to be a risk factor, and dentists should recognize BPPV as a possible complication of dental treatment.
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Affiliation(s)
- Tzu-Pu Chang
- Department of Neurology/Neuro-Medical Scientific Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yueh-Wen Lin
- Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Pi-Yu Sung
- Department of Physical Medicine and Rehabilitation, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Hsun-Yang Chuang
- Department of research, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Hsien-Yang Chung
- Department of Dentistry, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Wen-Ling Liao
- Department of Physical Medicine and Rehabilitation, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
- * E-mail:
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Saeed BMN, Omari AF. Climatic variations and benign paroxysmal positional vertigo. J Otol 2016; 11:33-37. [PMID: 29937808 PMCID: PMC6002593 DOI: 10.1016/j.joto.2016.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/03/2016] [Accepted: 03/04/2016] [Indexed: 11/30/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) is probably the most common diagnosis at vertigo clinics. Seasonal cycles of several human illnesses could be attributed variously to changes in atmospheric or weather conditions. In this retrospective study, patients with BPPV from January 2010 to December 2012 were studied, and their charts were reviewed. Statistical analysis revealed a statistically significant difference in patients' numbers among different months of the year. Also there is a significant statistical correlation between the numbers of patients with climatic variations especially the temperature. The present paper discusses the possible explanations for these results which confirms the seasonal variations in BPPV, together with a review of literature to view the possible associations with other disorders that causes such seasonality.
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Affiliation(s)
- Basil M N Saeed
- Department of Surgery, College of Medicine, Mosul University, Duhok, Kurdistan, Iraq
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83
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Brosel S, Laub C, Averdam A, Bender A, Elstner M. Molecular aging of the mammalian vestibular system. Ageing Res Rev 2016; 26:72-80. [PMID: 26739358 DOI: 10.1016/j.arr.2015.12.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 12/16/2015] [Accepted: 12/21/2015] [Indexed: 12/18/2022]
Abstract
Dizziness and imbalance frequently affect the elderly and contribute to falls and frailty. In many geriatric patients, clinical testing uncovers a dysfunction of the vestibular system, but no specific etiology can be identified. Neuropathological studies have demonstrated age-related degeneration of peripheral and central vestibular neurons, but the molecular mechanisms are poorly understood. In contrast, recent studies into age-related hearing loss strongly implicate mitochondrial dysfunction, oxidative stress and apoptotic cell death of cochlear hair cells. While some data suggest that analogous biological pathomechanisms may underlie vestibular dysfunction, actual proof is missing. In this review, we summarize the available data on the molecular causes of vestibular dysfunction.
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Affiliation(s)
- Sonja Brosel
- German Center for Vertigo and Balance Disorders, Department of Neurology, Klinikum Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, 81377 Munich, Germany.
| | - Christoph Laub
- Department of Neurology with Friedrich-Baur-Institute, Klinikum Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, 81377 Munich, Germany
| | - Anne Averdam
- Department of Neurology with Friedrich-Baur-Institute, Klinikum Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, 81377 Munich, Germany
| | - Andreas Bender
- Department of Neurology, Therapiezentrum Burgau, Kapuzinerstr.34, 89331 Burgau, Germany
| | - Matthias Elstner
- Department of Neurology with Friedrich-Baur-Institute, Klinikum Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, 81377 Munich, Germany; Department of Neurology and Clinical Neurophysiology, Academic Hospital Munich-Bogenhausen, Technical University of Munich, Englschalkingerstr. 77, 81925 Munich, Germany
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84
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Parham K, Kuchel GA. A Geriatric Perspective on Benign Paroxysmal Positional Vertigo. J Am Geriatr Soc 2016; 64:378-85. [PMID: 26804483 DOI: 10.1111/jgs.13926] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo in older adults. Beyond the unpleasant sensation of vertigo, BPPV also negatively affects older adults' gait and balance and increases their risk of falling. As such it has a profound effect on function, independence, and quality of life. Otoconia are the inner ear structures that help detect horizontal and vertical movements. Aging contributes to the fragmentation of otoconia, whose displacement into the semicircular, most commonly posterior canals, can produce rotatory movement sensations with head movement. BPPV is more commonly idiopathic in older adults than in younger individuals, can present atypically, and has a more-protracted course and higher risk of recurrence. Medications such as meclizine that are commonly prescribed for BPPV can be associated with significant side effects. Dix-Hallpike and Head Roll tests can generally identify the involved canal. Symptoms resolve as otoconia fragments dissolve into the endolymph, but appropriate canalith repositioning (e.g., Epley maneuver) can expedite recovery and reduce the burden of this disorder. Observations suggesting an association between idiopathic BPPV and vitamin D deficiency and osteoporosis indicate that BPPV may share risk factors with other common geriatric conditions, which highlights the importance of moving beyond purely otological considerations and addressing the needs of older adults with vertigo through a systems-based multidisciplinary approach.
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Affiliation(s)
- Kourosh Parham
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, UCONN Health, Farmington, Connecticut
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85
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Nuti D, Masini M, Mandalà M. Benign paroxysmal positional vertigo and its variants. HANDBOOK OF CLINICAL NEUROLOGY 2016; 137:241-56. [PMID: 27638076 DOI: 10.1016/b978-0-444-63437-5.00018-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Benign paroxysmal positional vertigo is a common labyrinthine disorder caused by a mechanic stimulation of the vestibular receptors within the semicircular canals. It is characterized by positional vertigo and positional nystagmus, both provoked by changes in the position of the head with respect to gravity. The social impact of the disease and its direct and indirect costs to healthcare systems are significant owing to impairment of daily activities and increased risk of falls. The first description of a patient with benign paroxysmal positional vertigo is from Robert Bárány in 1921, but the features of the syndrome and the diagnostic maneuver were well described by Dix and Hallpike in 1952. Since then, the gradually increasing interest of otolaryngologists and neurologists has led to a progressive advance in the knowledge of this labyrinthine disorder with regard to its epidemiologic, pathophysiologic, clinical, and therapeutic aspects. Despite the often effective diagnosis and treatment of most cases of benign paroxysmal positional vertigo, the physiopathologic explanations of the disease are mainly speculative. In this chapter, we describe the epidemiologic, pathophysiologic, clinical, and therapeutic aspects of benign paroxysmal positional vertigo.
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Affiliation(s)
- D Nuti
- Department of Otology and Skull Base Surgery, University of Siena, Siena, Italy.
| | - M Masini
- Department of Social, Political and Cognitive Sciences, University of Siena, Siena, Italy
| | - M Mandalà
- Department of Otology and Skull Base Surgery, University of Siena, Siena, Italy
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86
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Abstract
This chapter gives an overview of the epidemiology of dizziness, vertigo, and imbalance, and of specific vestibular disorders. In the last decade, population-based epidemiologic studies have complemented previous publications from specialized settings and provided evidence for the high burden of dizziness and vertigo in the community. Dizziness (including vertigo) affects about 15% to over 20% of adults yearly in large population-based studies. Vestibular vertigo accounts for about a quarter of dizziness complaints and has a 12-month prevalence of 5% and an annual incidence of 1.4%. Its prevalence rises with age and is about two to three times higher in women than in men. Imbalance has been increasingly studied as a highly prevalent complaint particularly affecting healthy aging. Studies have documented the high prevalence of benign paroxysmal positional vertigo (BPPV) and vestibular migraine (VM), as well as of comorbid anxiety at the population level. BPPV and VM are largely underdiagnosed, while Menière's disease, which is about 10 times less frequent than BPPV, appears to be overdiagnosed. Risk factor research is only at its beginning, but has provided some interesting observations, such as the consistent association of vertigo and migraine, which has greatly contributed to the recognition of VM as a distinct vestibular syndrome.
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Affiliation(s)
- H K Neuhauser
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
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87
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Li J, Guo P, Tian S, Li K, Zhang H. Quick repositioning maneuver for horizontal semicircular canal benign paroxysmal positional vertigo. J Otol 2015; 10:115-117. [PMID: 29937793 PMCID: PMC6002574 DOI: 10.1016/j.joto.2015.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 11/13/2015] [Accepted: 11/16/2015] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the efficacy of quick repositioning maneuver for horizontal semicircular canal benign paroxysmal positional vertigo (H-BPPV). Methods Clinical data of 67 patients with H-BPPV who underwent quick repositioning maneuver in our hospital from July 2009 to November 2014 were retrospectively analyzed. The maneuver involved rotating the patient in the axial plane for 180° from the involved side towards contralateral side as quickly as possible. Results Complete symptom resolution was achieved in 61 patients (91.0%) at one week and in 64 patients (95.5%) at 3 months post-treatment. During the repositioning maneuver process, there were no obvious untoward responses except transient nausea with or without vomiting in a few patients. Conclusion The results indicate that the quick repositioning maneuver is an easy and effective alternative treatment in the management of H-BPPV.
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Affiliation(s)
- Jinrang Li
- Department of Otorhinolaryngology Head Neck Surgery, Navy General Hospital, Beijing, 100048, China
| | - Pengfei Guo
- Department of Otorhinolaryngology Head Neck Surgery, Navy General Hospital, Beijing, 100048, China
| | - Shiyu Tian
- Department of Otorhinolaryngology Head Neck Surgery, Navy General Hospital, Beijing, 100048, China
| | - Keliang Li
- Department of Otorhinolaryngology Head Neck Surgery, Navy General Hospital, Beijing, 100048, China
| | - Hao Zhang
- Department of Otorhinolaryngology Head Neck Surgery, Navy General Hospital, Beijing, 100048, China
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88
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Effectiveness of the Parnes particle repositioning manoeuvre for posterior canal benign paroxysmal positional vertigo. The Journal of Laryngology & Otology 2015; 129:1188-93. [PMID: 26456180 DOI: 10.1017/s0022215115002704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Benign paroxysmal positional vertigo is a common vestibular disorder that negatively affects an individual's health-related quality of life. This study aimed to examine the effectiveness of the Parnes particle repositioning manoeuvre as an intervention for individuals with posterior canal benign paroxysmal positional vertigo. METHODS The de-identified records of 155 individuals treated with the Parnes manoeuvre were examined. Descriptive statistics were calculated, including the frequency and valid per cent of participants whose nystagmus was resolved with the Parnes manoeuvre. RESULTS In all, nystagmus was resolved with the Parnes manoeuvre in 145 participants (93.5 per cent). The mean number of manoeuvres needed to resolve the nystagmus was 1.3. CONCLUSION The Parnes manoeuvre proved to be as effective as the Epley canalith repositioning manoeuvre, currently the most common intervention, in treating individuals with posterior canal benign paroxysmal positional vertigo.
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Sari K, Yildirim T, Borekci H, Akin I, Aydin R, Ozkiris M. The relationship between benign paroxysmal positional vertigo and thyroid autoimmunity. Acta Otolaryngol 2015; 135:754-7. [PMID: 25761528 DOI: 10.3109/00016489.2015.1021932] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Although there have been few studies concerning BPPV and thyroid autoimmunity and a positive relation was found between them, this study didn't find any relation between BPPV and thyroid autoimmunity. IT is thought that further large-scale studies must be done to clarify the relation. OBJECTIVES Benign paroxysmal positional vertigo (BPPV) consists of ∼ 20% of vestibular disorders. Self-limited rotatory nystagmus with positional vertigo are the main findings of BPPV. Although canalolithiasis theory was confirmed by demonstrating freely floating debris in the endolymph of the posterior semicircular channel in following studies, currently, the etiology hasn't been explained totally. This study investigated the relation of BPPV and thyroid autoimmunity evaluated via measurement of serum thyroid autoantibodies. METHOD Fifty patients (37 female, 13 male) with BPPV (BPPV group), 52 patients (40 female, 12 male) with non-BPPV vertigo (non-BPPV group) and 60 otherwise normal control (38 female, 22 male) samples were enrolled in the study. All samples of BPPV, non-BPPV groups and controls had undergone a cochleovestibular test following thorough ENT examination. After blood samples were drawn from each subject, thyroid-stimulating hormone (TSH), anti-thyroid peroxidase antibody (TPO-Ab) and anti-thyroglobulin antibody (TG-Ab) levels were measured accordingly. RESULTS In the study, eight patients of the BPPV group (16%) had a high thyroid antibody level. In the non-BPPV group, six patients (11.5%) had elevated thyroid antibodies. In the control group, 15 patients (25%) had elevated thyroid antibodies. TSH values of all subjects were detected to be within normal range. No statistical difference was found between the groups with respect to TG-Ab and TPO-Ab values (p-values = 0.729 and 0.812, respectively).
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Affiliation(s)
- Kamran Sari
- Department of Otolaryngology & Head and Neck Surgery
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90
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Benign paroxysmal positional vertigo is associated with an increased risk of fracture: a population-based cohort study. J Orthop Sports Phys Ther 2015; 45:406-12. [PMID: 25808526 DOI: 10.2519/jospt.2015.5707] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN A nationwide, population-based, retrospective cohort study. OBJECTIVES To investigate whether benign paroxysmal positional vertigo (BPPV) is associated with an increased risk of fracture. BACKGROUND Benign paroxysmal positional vertigo is a brief rotational vertigo induced by head position change that may increase the risk of falls and, therefore, fracture. METHODS Data from the Taiwan National Health Insurance Research Database were used for this study. We selected a case cohort comprising 3796 patients aged over 20 years who were newly diagnosed with BPPV between 2000 and 2006. In addition, we randomly selected a control cohort of 15 184 individuals without BPPV. Patients with BPPV were matched to individuals in the control group according to sex, age, and index year. A Cox proportional hazard regression was performed to compute the hazard ratio of fracture, after adjusting for demographic characteristics and comorbidities. RESULTS The prevalence of comorbidities was higher among patients with BPPV. After adjusting for age, sex, and comorbidities, patients with BPPV exhibited a 1.14-fold (95% confidence interval [CI]: 1.04, 1.25; P<.01) higher risk of fracture than those without BPPV. Trunk fracture (vertebra, rib, and pelvis) was the fracture type with the highest adjusted hazard ratio (1.24; 95% CI: 1.06, 1.45; P<.01) in patients with BPPV relative to those without BPPV. An analysis stratified according to demographic factors revealed that men with BPPV exhibited a 1.43-fold (95% CI: 1.22, 1.66; P<.001) higher risk of fracture. Patients with BPPV aged over 65 years exhibited a significantly higher risk of fracture (adjusted hazard ratio = 1.17; 95% CI: 1.03, 1.33; P<.05) than did those without BPPV. CONCLUSION Patients with BPPV exhibited a higher risk of fracture than did those without BPPV. LEVEL OF EVIDENCE Prognosis, level 2b.
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92
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Ogun OA, Janky KL, Cohn ES, Büki B, Lundberg YW. Gender-based comorbidity in benign paroxysmal positional vertigo. PLoS One 2014; 9:e105546. [PMID: 25187992 PMCID: PMC4154861 DOI: 10.1371/journal.pone.0105546] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 07/24/2014] [Indexed: 11/19/2022] Open
Abstract
It has been noted that benign paroxysmal positional vertigo (BPPV) may be associated with certain disorders and medical procedures. However, most studies to date were done in Europe, and epidemiological data on the United States (US) population are scarce. Gender-based information is even rarer. Furthermore, it is difficult to assess the relative prevalence of each type of association based solely on literature data, because different comorbidities were reported by various groups from different countries using different patient populations and possibly different inclusion/exclusion criteria. In this study, we surveyed and analyzed a large adult BPPV population (n = 1,360 surveyed, 227 completed, most of which were recurrent BPPV cases) from Omaha, NE, US, and its vicinity, all diagnosed at Boys Town National Research Hospital (BTNRH) over the past decade using established and consistent diagnostic criteria. In addition, we performed a retrospective analysis of patients' diagnostic records (n = 1,377, with 1,360 adults and 17 children). The following comorbidities were found to be significantly more prevalent in the BPPV population when compared to the age- and gender-matched general population: ear/hearing problems, head injury, thyroid problems, allergies, high cholesterol, headaches, and numbness/paralysis. There were gender differences in the comorbidities. In addition, familial predisposition was fairly common among the participants. Thus, the data confirm some previously reported comorbidities, identify new ones (hearing loss, thyroid problems, high cholesterol, and numbness/paralysis), and suggest possible predisposing and triggering factors and events for BPPV.
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Affiliation(s)
| | - Kristen L. Janky
- Boys Town National Research Hospital, Omaha, Nebraska, United States of America
| | - Edward S. Cohn
- Boys Town National Research Hospital, Omaha, Nebraska, United States of America
| | - Bela Büki
- Department of Otolaryngology, Karl Landsteiner University Hospital Krems, Krems an der Donau, Austria
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93
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Abstract
Benign paroxysmal positional vertigo (BPPV), the most common cause of dizziness, occurs in all age groups. It presents with vertigo on head movement, but in older patients presentation may be typical and thus accounting for a low recognition rate in the primary care setting. It may be recurrent in up to 50% of cases. BPPV is associated with displacement of fragments of utricular otoconia into the semicircular canals, most commonly the posterior semicircular canal. Otoconia are composed of otoconin and otolin forming the organic matrix on which calcium carbonate mineralizes. Otoconia may fragment with trauma, age, or changes in the physiology of endolymph (e.g., pH and calcium concentration). Presentation varied because otoconia fragments can be displaced into any of the semicircular canals on either (or both) side and may be free floating (canalolithiasis) or attached to the cupula (cupulolithiasis). Most cases of BPPV are idiopathic, but head trauma, otologic disorders, and systemic disease appear to be contributory in a subset. Positional maneuvers are used to diagnose and treat the majority of cases. In rare intractable cases surgical management may be considered. A strong association with osteoporosis suggests that idiopathic BPPV may have diagnostic and management implications beyond that of a purely otologic condition.
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94
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Low bone mineral density and vitamin D deficiency in patients with benign positional paroxysmal vertigo. Eur Arch Otorhinolaryngol 2014; 272:2249-53. [DOI: 10.1007/s00405-014-3175-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 06/22/2014] [Indexed: 10/25/2022]
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95
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Yu S, Liu F, Cheng Z, Wang Q. Association between osteoporosis and benign paroxysmal positional vertigo: a systematic review. BMC Neurol 2014; 14:110. [PMID: 24886504 PMCID: PMC4039044 DOI: 10.1186/1471-2377-14-110] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 05/14/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increasing recent evidence has implicated osteoporosis as a risk factor for benign paroxysmal positional vertigo (BPPV). We conducted a systematic review to examine the association between osteoporosis and BPPV. METHODS Four electronic databases (PubMed, EMBASE, Cochrane Library, and the China Network Knowledge Infrastructure) were searched to identify all papers, published in either English or Chinese, examining the association between osteoporosis (osteopenia) and BPPV. RESULTS Seven studies were eligible for analysis, though these studies included some weaknesses. Most of the studies demonstrated a correlation between osteoporosis (osteopenia) and the occurrence and recurrence of BPPV, especially in older women. Patients with osteoporosis may require more canalith-repositioning procedures. CONCLUSIONS This systematic review provides insight into currently available evidence and elucidates the possible existence of an association between BPPV and osteoporosis (osteopenia). However, the evidence supporting that conclusion is not strong, and further studies are needed to clarify the association between these conditions.
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Affiliation(s)
| | | | | | - Qirong Wang
- Department of Otolaryngology, Shandong Qianfoshan Hospital, 16766 Jingshi Road, Jinan 250014, PR China.
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96
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In vitro calcite crystal morphology is modulated by otoconial proteins otolin-1 and otoconin-90. PLoS One 2014; 9:e95333. [PMID: 24748133 PMCID: PMC3991680 DOI: 10.1371/journal.pone.0095333] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 03/25/2014] [Indexed: 11/19/2022] Open
Abstract
Otoconia are formed embryonically and are instrumental in detecting linear acceleration and gravity. Degeneration and fragmentation of otoconia in elderly patients leads to imbalance resulting in higher frequency of falls that are positively correlated with the incidence of bone fractures and death. In this work we investigate the roles otoconial proteins Otolin-1 and Otoconin 90 (OC90) perform in the formation of otoconia. We demonstrate by rotary shadowing and atomic force microscopy (AFM) experiments that Otolin-1 forms homomeric protein complexes and self-assembled networks supporting the hypothesis that Otolin-1 serves as a scaffold protein of otoconia. Our calcium carbonate crystal growth data demonstrate that Otolin-1 and OC90 modulate in vitro calcite crystal morphology but neither protein is sufficient to produce the shape of otoconia. Coadministration of these proteins produces synergistic effects on crystal morphology that contribute to morphology resembling otoconia.
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97
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Celikbilek A, Gencer ZK, Saydam L, Zararsiz G, Tanik N, Ozkiris M. Serum uric acid levels correlate with benign paroxysmal positional vertigo. Eur J Neurol 2013; 21:79-85. [DOI: 10.1111/ene.12248] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 07/09/2013] [Indexed: 11/30/2022]
Affiliation(s)
- A. Celikbilek
- Department of Neurology; Medical School; Bozok University; Yozgat Turkey
| | - Z. K. Gencer
- Department of Otolaryngology; Medical School; Bozok University; Yozgat Turkey
| | - L. Saydam
- Department of Otolaryngology; Medical School; Bozok University; Yozgat Turkey
| | - G. Zararsiz
- Department of Biostatistics; Medical School; Hacettepe University; Ankara Turkey
| | - N. Tanik
- Department of Neurology; Medical School; Bozok University; Yozgat Turkey
| | - M. Ozkiris
- Department of Otolaryngology; Medical School; Bozok University; Yozgat Turkey
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98
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Parham K, Leonard G, Feinn RS, Lafreniere D, Kenny AM. Prospective clinical investigation of the relationship between idiopathic benign paroxysmal positional vertigo and bone turnover. Laryngoscope 2013; 123:2834-9. [DOI: 10.1002/lary.24162] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 03/27/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Kourosh Parham
- Division of Otolaryngology-Head and Neck Surgery; Department of Surgery; University of Connecticut Health Center; Farmington Connecticut U.S.A
| | - Gerald Leonard
- Division of Otolaryngology-Head and Neck Surgery; Department of Surgery; University of Connecticut Health Center; Farmington Connecticut U.S.A
| | - Richard S. Feinn
- Frank Netter School of Medicine; Quinnipiac University; Hamden Connecticut U.S.A
| | - Denis Lafreniere
- Division of Otolaryngology-Head and Neck Surgery; Department of Surgery; University of Connecticut Health Center; Farmington Connecticut U.S.A
| | - Anne M. Kenny
- Center on Aging; University of Connecticut Health Center; Farmington Connecticut U.S.A
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Yamanaka T, Shirota S, Sawai Y, Murai T, Fujita N, Hosoi H. Osteoporosis as a risk factor for the recurrence of benign paroxysmal positional vertigo. Laryngoscope 2013; 123:2813-6. [PMID: 23568754 DOI: 10.1002/lary.24099] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 02/04/2013] [Accepted: 02/21/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Benign paroxysmal positional vertigo (BPPV) frequently occurs in females over 50 years old, suggesting that a postmenopausal decrease in estrogen secretion might be involved in its onset. An estrogen deficiency is generally known to cause osteoporosis through a reduction in bone mass. This study was designed to investigate a clinical association between idiopathic BPPV and osteoporosis. STUDY DESIGN Case-control study. METHODS We measured the bone mineral density (BMD) at the lumbar vertebrae in 61 patients with idiopathic BPPV who were postmenopausal women over 50 years old using dual-energy x-ray absorptiometry. After being treated with the canalith repositioning maneuver, the patients were followed up for at least 1 year. RESULTS Our results showed that the incidence of osteoporosis in patients with BPPV was 26.2%, which was similar to those observed in epidemiological surveys conducted in Japan. However, we found that in BPPV patients with osteoporosis, the incidence of recurrence was 56.3%, which was significantly higher than that observed in patients with normal bone mineral density (16.1%). Furthermore, the frequency of BPPV recurrence increased as BMD decreased. CONCLUSIONS These results suggest that osteoporosis is a risk factor for BPPV recurrence. The prognosis of BPPV might be clinically predicted by BMD reduction.
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Affiliation(s)
- Toshiaki Yamanaka
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University School of Medicine, Nara, Japan; and the
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100
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Büki B, Ecker M, Jünger H, Lundberg YW. Vitamin D deficiency and benign paroxysmal positioning vertigo. Med Hypotheses 2012; 80:201-4. [PMID: 23245911 DOI: 10.1016/j.mehy.2012.11.029] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Accepted: 11/17/2012] [Indexed: 01/01/2023]
Abstract
Benign paroxysmal positional vertigo is a common cause of disabling vertigo with a high rate of recurrence. Although connections between vitamin D deficiency and osteoporosis, as well as between osteoporosis and benign paroxysmal positional vertigo have been suggested respectively in the literature, we are not aware of any publication linking vitamin D and benign paroxysmal positional vertigo. As a hypothesis, we suggest that there is a relation between insufficient vitamin D level and benign paroxysmal positional vertigo. In order to test this hypothesis, in a small retrospective pilot study, 25-hydroxyvitamin D levels in serum of patients with benign paroxysmal positional vertigo and frequency of recurrence after correction of serum level were assessed retrospectively. Patients with idiopathic positional vertigo had a low average serum level of 25-hydroxyvitamin D (23ng/mL) similar to that of the general Austrian population, which has a high prevalence of hypovitaminosis D. In 4 cases with chronically recurrent severe vertigo episodes, average levels of serum 25-hydroxyvitamin D were even significantly lower than in the other vertigo patients, who had their first episode. Vertigo attacks did not recur after supplementation with vitamin D. We raise the possibility that patients with benign paroxysmal positional vertigo who have low vitamin D levels may benefit from supplementation and suggest further epidemiological investigations to determine the effect of correcting vitamin D deficiency on the recurrence of vertigo. Given the many known benefits of vitamin D, the authors recommend the measurement of vitamin D in patients with benign paroxysmal positional vertigo and supplementation if necessary.
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Affiliation(s)
- Béla Büki
- Department of Otolaryngology, County Hospital Krems, Austria.
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