Serum vitamin D and recurrent benign paroxysmal positional vertigo

Risk Factors for Recurrence of Benign Paroxysmal Positional Vertigo: A Prospective Study

OBJECTIVES

Benign paroxysmal positional vertigo (BPPV) can be treated successfully in most cases. However, recurrences are common. We aimed to prospectively investigate demographic and clinical risk factors for BPPV recurrence. Our second aim was to investigate whether seasonality affects recurrences.

METHODS

We recruited adult Dutch patients presenting at our dizziness clinic with a diagnosis of definite or possible BPPV for a prospective observational study with 1-year follow-up. Factors collected from patient history and questionnaires were age, sex, ethnicity, previous treatment for BPPV, duration of BPPV symptoms, number of treatment sessions for the initial BPPV episode, the affected canal, recent head trauma, and a history of vestibular neuritis, Menière's disease, (vestibular) migraine, gout, diabetes mellitus, and chronic renal failure. Factors derived from blood samples were uric acid, glycated hemoglobin, and 25-hydroxyvitamin D.

RESULTS

We included 139 subjects with a mean age of 65 (SD, 13) years, of whom 70% was female. A total of 48 subjects (34.5%) suffered from at least one recurrence during the 1-year follow-up. Independent risk factors for recurrence of BPPV were "multiple treatment sessions for the initial BPPV episode" (incidence rate ratio, 1.74; 95% confidence interval 1.06-2.85; p = 0.027) and history of gout (incidence rate ratio, 1.90; 95% confidence interval, 1.01-3.57; p = 0.045).

CONCLUSION

One-third of patients presenting in a tertiary dizziness clinic develop at least one recurrence of BPPV within 1 year. Multiple treatment sessions and a history of gout are independent risk factors for recurrence.

Vertigo During Pregnancy: A Narrative Review of the Etiology, Pathophysiology, and Treatment

From the time of conception until the time of labor, a woman's body and mind undergo a variety of hormonal and other changes. Patients may also experience vertigo and a lack of balance during this period. Disabling and physically painful, these symptoms may strike at any moment. Pregnancy-related vertigo has been the focus of several studies. We looked at the research on vertigo in pregnant women in detail. This narrative review aims to examine the causes, pathophysiology, and current treatments for vertigo during pregnancy. Vertigo during pregnancy has a diverse etiology, with typical causes including hormonal changes and modifications in vascular dynamics. Vertigo may start to appear due to pathophysiological mechanisms involving vestibular and central nervous system adaptations. Numerous alternatives for treatment are available, including dietary changes, vestibular therapy, medicines, and surgical procedures. The thorough assessment of the current research on vertigo during pregnancy provided by this narrative review will help medical practitioners make wise clinical decisions.

Vitamin D Supplementation and Recurrence of Benign Paroxysmal Positional Vertigo

Positional vertigo manifests as a spinning sensation triggered by changes in head position relative to gravity. Benign paroxysmal positional vertigo (BPPV) is an inner ear disorder characterized by recurrent episodes of positional vertigo. The connection between vitamin D insufficiency/deficiency and the onset and recurrence of BPPV is established. This study aims to assess vitamin D as a recurring factor in BPPV and the efficacy of vitamin D supplementation in preventing its recurrence. A comprehensive literature review on the relationship between vitamin D and BPPV recurrence was conducted, searching PubMed, Embase, Web of Science, and article reference lists for studies published from 2020 to 2023. A total of 79 articles were initially identified through the search, with 12 of them being utilized in the study. Recurrence rates for BPPV varied from 13.7% to 23% for studies with follow-up less than 1 year and 13.3% to 65% for studies with follow-up equal to or exceeding 2 years. Risk factors for BPPV recurrence include advanced age, female sex, hypertension, diabetes mellitus, hyperlipidemia, osteoporosis, and vitamin D deficiency. While earlier studies did not establish a link between low vitamin D levels and initial BPPV occurrence, they did associate recurrent episodes with low vitamin D levels. Recent research indicates that vitamin D supplementation in BPPV patients with deficiency or insufficiency decreases both the numbers of relapsing patients and relapses per patient. To validate these findings across diverse populations, further randomized controlled studies with larger cohorts and extended follow-up durations are essential.

Vitamin D supplementation in preventing the recurrence of benign paroxysmal positional vertigo

Objective

To evaluate the effect of vitamin D supplementation on the recurrence rate of benign paroxysmal positional vertigo (BPPV).

Methods

A single-center, prospective, double-blind, placebo-controlled, parallel-group randomized controlled trial was conducted between November 2018 and May 2020. After successful treatment with canalith repositioning maneuvers, patients diagnosed with BPPV were randomized to either the vitamin D (n = 20) or placebo (n = 18) group. Only patients with serum vitamin D levels <20 ng mL-1 were included. The vitamin D group received 7000 IU of vitamin D weekly for a year, while the placebo group received a matching placebo drug. The final endpoint was the BPPV recurrence rate and correlation with serum vitamin D levels after 6 and 12 months in both groups.

Results

Among 38 patients, 37 were followed up for 6 months and 30 for 12 months. Significantly higher serum vitamin D levels were observed in the vitamin D group compared to the placebo group at both the 6-month and 1-year follow-ups (p < .001 at each timepoint). The recurrence rate was lower in the vitamin D group than in the placebo group after 6 months (p = .008) and 1 year (p = .003).

Conclusion

Vitamin D supplementation, in the absence of calcium, may be beneficial for patients prone to recurrent BPPV episodes, particularly when serum vitamin D levels are suboptimal (PRE20181024-001, Clinical Research Information Service, South Korea).

Level of Evidence

1b.

When Particle Repositioning Maneuvers Just Will Not Stick: Clinical Considerations for Persistent Benign Paroxysmal Positional Vertigo

PURPOSE

Although benign paroxysmal positional vertigo (BPPV) is often considered benign and easily treatable, aberrant cases of persistent BPPV can be challenging to manage. Detailed differential diagnosis is essential as central-, vascular-, and cervical-related etiologies may mirror the presentation of persistent BPPV. In addition, an understanding of alternative noninvasive treatment options is important as persistent BPPV is often refractory to traditional particle repositioning maneuvers (PRMs). This article reviews clinical considerations for persistent BPPV.

METHOD

A case of a 68-year-old male diagnosed with posterior semicircular canal BPPV (PC-BPPV) and received various unsuccessful PRMs treatments is described. His clinical presentation is referenced alongside various possible etiologies to discern the most likely diagnosis. Nonsurgical treatment options for intractable PC-BPPV will also be reviewed.

CONCLUSIONS

BPPV recalcitrant to PRM treatment warrants investigation of other etiologies; however, key elements of the case history and objective examination are helpful for differential diagnosis. Brandt-Daroff exercises may facilitate habituation of symptoms secondary to persistent BPPV. More research is needed to understand the use of multiaxial repositioning chairs for the treatment of intractable BPPV.

Low vitamin D and uric acid status in patients with benign paroxysmal positional vertigo

PURPOSE

Growing evidence reported that vitamin D and uric acid metabolism played roles in the occurrence of benign paroxysmal positional vertigo, an otoconia-related vestibular disorder. We aimed to investigate the serum 25-hydroxy vitamin D (25(OH)D) and uric acid in patients with benign paroxysmal positional vertigo and to determine the risk factor for benign paroxysmal positional vertigo.

METHODS

This case-control study comprised 182 patients with benign paroxysmal positional vertigo and 182 age- and gender-matched controls. All subjects' age, body mass index, systolic blood pressure, diastolic blood pressure, 25-hydroxyvitamin D (25(OH)D), uric acid and serum calcium measurements were analyzed.

RESULTS

We found a female preponderance of benign paroxysmal positional vertigo patients, with a median of 60 (52-66) years old. The results showed low vitamin D status both in benign paroxysmal positional vertigo and controls, with no significant difference of 25(OH)D levels between benign paroxysmal positional vertigo patients and controls (P > 0.05). Compared with the control group, patients with benign paroxysmal positional vertigo had a higher prevalence of vitamin D deficiency and a lower prevalence of vitamin D sufficiency (P < 0.05). Uric acid was significantly lower in the benign paroxysmal positional vertigo groups (P < 0.05). Logistic regression analysis revealed that age and uric acid were considered higher risk predictors for benign paroxysmal positional vertigo.

CONCLUSION

Our study observed low vitamin D status in patients with benign paroxysmal positional vertigo, with no significant differences of the 25(OH)D level in patients with benign paroxysmal positional vertigo and controls. Elderly, vitamin D deficiency and low uric acid levels may be risk factors for benign paroxysmal positional vertigo occurrence.

Outcome of canalith repositioning manoeuvre in benign paroxysmal positional vertigo in children and adolescents: A systematic review

BACKGROUND

Benign paroxysmal positional vertigo (BPPV) is a debilitating condition that has been significantly described in adults. Recent data points out that BPPV occurs in children as well. Canalith repositioning manoeuvre (CRM) has shown promising results amongst adult patients with BPPV.

OBJECTIVE

We reviewed the literature to determine the outcome of CRM in children and adolescents with BPPV.

METHODS

A literature search was conducted over 1 month (March 2022). The primary outcome was defined as the resolution of positional nystagmus and symptoms, and secondary outcomes were determined by the presence of recurrence and the number of attempts of CRM.

RESULTS

Ten articles were selected based on our objective and selection criteria. A total of 242 patients were included, with a mean of 10.9 years. BPPV was diagnosed based on history and positional nystagmus in all patients (100%). CRM was performed in 97.9% of patients, whereby 80.5% recovered following a single attempt of CRM. Recurrence of symptoms was identified in 10% of patients with no reported major complications.

CONCLUSION

CRM has demonstrated promising results in children and adolescents. The quality of evidence is limited until a better-quality study involving randomised controlled studies with a larger sample size is completed.

Evaluation of a questionnaire as a screening tool for benign paroxysmal position vertigo

OBJECTIVE

To determine the value of a questionnaire as a screening tool for benign paroxysmal position vertigo (BPPV).

STUDY DESIGN

Retrospective chart review.

SETTING

Tertiary care centers.

METHODS

A total of 520 vertigo adults completed the questionnaire before the diagnosis was confirmed. After vestibular function examination and other diagnostic examination, the diagnosis of all participants was confirmed by experts. By validating valuable items from the questionnaire with 47 items, a new questionnaire of 5 items was formed to quickly diagnose BPPV. The internal consistency of the new questionnaire and validity were evaluated. The correlation between the score obtained from the new questionnaire and diagnosis was investigated. The mean score was also compared between groups with and without BPPV and diagnostic precision measures were calculated.

RESULTS

520 vertigo participants answered all the question completely and BPPV was identified in 138 participants (26.5%). The responses to questionnaire revealed preferable reproducibility (r = 0.898, P < 0.05) and internal consistency (Cronbach's α = 0.702) as well as the validity (Kaiser-Meyer-Olkin, KMO = 0.731). The higher the individual score, the more likely to be BPPV (B = 2.082; P < 0.05). The mean score of answers was greater in the group with a clinical diagnosis of BPPV compared to those without BPPV (F = 58.459, P < 0.05). The sensitivity of the screening tool was 92.8% and specificity was 88.5%, with an area under the ROC curve of 0.946 (95% confidence interval 0.926-0.965; P < 0.05).

CONCLUSION

The questionnaire proved to be of great value to screen for individuals with possible BPPV.

Characteristics of Benign Paroxysmal Positional Vertigo in Young Children

OBJECTIVES

This study aimed to determine the clinical characteristics of benign paroxysmal positional vertigo (BPPV) in young children.

STUDY DESIGN

Retrospective case review.

METHODS

All children <10 years old that have been diagnosed with BPPV at our pediatric vestibular program between December 2012-July 2021 were selected. Clinical features were identified by medical record review, including demographics, comorbidities, canal involvement, response to treatment, and incidence of recurrence.

RESULTS

A total of 34 children were diagnosed with BPPV with a mean age of 7.9 years old (SD ± 1/7; range 5-9) at the time of diagnosis and a male:female ratio of 1:1. Involved semicircular canals included posterior in 82% (n = 28), horizontal in 41% (n = 14), and superior in 24% (n = 8) of patients, respectively. Comorbid diagnoses included migraine (n = 14), concussion (n = 10), acute vestibular syndrome (n = 4), and persistent postural perceptual dizziness (n = 6). Recurrence with initially confirmed resolution occurred in 10 patients (29%) with a mean of 2.5 recurrences per patient (SD: 2.2; range 1-8). A family history of vertigo or migraine was identified in 11 and 17 patients, respectively.

CONCLUSIONS

BPPV is a cause of vertigo in children that may be overlooked. A relatively high proportion of patients demonstrated horizontal or superior canal involvement, recurrence, and additional comorbid causes of dizziness. Thus, providers evaluating young children with dizziness should perform diagnostic maneuvers to evaluate BPPV of all semicircular canals and continue to monitor children after successful treatment for recurrence.

LEVEL OF EVIDENCE

4, Case Series Laryngoscope, 133:694-699, 2023.

Effect of hormonal therapy on the otoconial changes caused by estrogen deficiency

Benign paroxysmal positional vertigo (BPPV) is associated with menopause and/or osteopenia. Morphological changes in the otoconial layer have been reported after ovariectomy (OVX). Moreover, hormone replacement therapy decreases BPPV risk. However, knowledge concerning the effect of hormonal therapy on the otoconial changes caused by estrogen deficiency is limited. We aimed to examine the effect of hormonal therapy on otoconial changes caused by estrogen deficiency. We hypothesized that hormonal therapy could reduce otoconial changes caused by OVX. Eight-week-old C57BL/6 mice were divided into four groups: sham operation with implantation of vehicle (sham + v), OVX with implantation of vehicle (OVX + v), OVX with implantation of estradiol (E2) (OVX + E2), and OVX with implantation of raloxifene (RAL) (OVX + RAL) groups. Otoconial layer volume was measured by micro-CT at 4 weeks after OVX or the sham operation. The otic bullae were removed; immunohistochemistry was performed for estrogen receptor alpha and 4-hydroxynonenal. Otoconial layer volume was significantly higher in the OVX + v than in the sham + v group. E2 and RAL significantly reduced these changes in the endometrial layer. The staining of estrogen receptor alpha and 4-hydroxynonenal were stronger in the OVX + v than in the sham + v group but equal in the sham + v, OVX + E2, and OVX + RAL groups. These results indicate that E2 and RAL are effective against morphological changes of the otoconial layer caused by estrogen deficiency via oxidative stress reduction.

Relation Between Posterior Canal Benign Paroxysmal Positional Vertigo and Vitamin D Deficiency

The aim of this study is to establish a relationship between vitamin D levels and benign paroxysmal positional vertigo (BPPV) and its recurrence; and to evaluate the remedial effect of vitamin D on BPPV. In a pilot study, 40 patients with clinically diagnosed posterior canal BPPV were evaluated, treated and were followed up for a period of 6 months at ENT Department of Mahatma Gandhi Medical College, Jaipur. All the patients with clinical diagnosis of posterior canal BPPV were tested for 25(OH)D levels at their 1st visit. Patients were divided in two groups after appropriate matching. Group A was given vitamin D supplementation along with canal repositioning manoeuvre (CRM) and group B were only treated by canal repositioning manoeuvre. Patients underwent neuro-otological assessment during follow up visits and recurrent attacks were recorded. This study was conducted on 40 patients with BPPV (26 females and 14 males). The average age was 50 years. Average serum of 25(OH)D at the first visit was (12.2 ng/ml) for group A, and (12.4 ng/ml) for group B, all patients had low serum level of 25(OH)D (below 20 ng/ml). Recurrent BPPV episodes, were significantly lower in group A than that of group B. We second the hypothesis that the patients with BPPV who have insufficient levels of Vitamin D may benefit from vitamin D supplementation and we suggest further epidemiological and pharmacological studies to detect the effect of vitamin D deficiency on development and recurrence of vertigo.

Prevention of Recurrent Benign Paroxysmal Positional Vertigo: The Role of Combined Supplementation with Vitamin D and Antioxidants

Benign paroxysmal positional vertigo (BPPV) usually has a favorable course, although it is possible to observe BPPV with a high recurrence rate. Previous studies suggested that vitamin D deficiency might affect BPPV recurrences, and oxidative stress might play a complementary role in BPPV pathogenesis. This multicentric trial aimed to evaluate the effectiveness of oral nutritional supplementation with a compound of alpha-lipoic acid, Carnosine, and Zinc (LICA® (Difass International, Coriano (RN), Italy)), vitamins of group B and vitamin D in preventing BPPV recurrences. A total of 128 patients with high recurrence-BPPV were randomized in three arms: Arm 1 consisted of subjects with “insufficient” or “deficient” vitamin D blood levels, treated with daily oral supplementation of LICA®, vitamins of group B and vitamin D3 (800 UI), Arm 2 included BPPV subjects with “sufficient” vitamin D who did not receive any nutritional support, and Arm 3 included subjects with a “sufficient” serum concentration of vitamin D who received supplementation with a compound of LICA® and Curcumin. After six months of follow-up, a significant reduction of BPPV relapses compared to the baseline was found only in Arm 1 (−2.32, 95% CI: 3.41−1.62, p-value < 0.0001). Study results suggested that oral nutritional supplementation with vitamin D3 plus antioxidants can prevent relapses in patients suffering from high recurrence-BPPV.

The Relationship Between Benign Paroxysmal Positional Vertigo and Vitamin D

Introduction Benign paroxysmal positional vertigo (BPPV) is a type of vertigo and its signs are short-time, severe attacks that occur in certain head and body positions. Recent studies have revealed that vitamin D deficiency correlates with BPPV and this is explained by cupulolithiasis and canalithiasis theories. Method In the present study, levels of serum vitamin D in the patients who were diagnosed as BPPV and those in the control group consisting of healthy individuals were investigated. In addition, it was examined whether vitamin D is influential on the rates of BPPV types. In our study, 258 patients who were diagnosed with BPPV after detailed ear-nose-throat and neurology examinations were examined. We compared the control group according to their ages, genders, and levels of vitamin D. In addition, we divided the BPPV group into two sub-groups according to their vitamin D levels (20-30 ng/ml and 20 g/ml lower), and each was compared by calculating vertigo types and ratios. Results The BPPV group included 187 females and 71 males, and their mean age was 43.70 ± 15.44. The control group consisted of 65 females and 35 males, and the mean age of this group was 44.63 ± 15.42. The mean vitamin D levels of the females and males were 18.42 ± 5.07 and 19.82 ± 5.11, respectively, in this study. On the other hand, the mean vitamin D levels of healthy females and males were found to be 30.88 ± 10.74. Conclusion Our study found that the vitamin D levels of the individuals in the BPPV group were statistically significantly lower than those of the individuals who were in the control group. However, it was observed that vitamin D did not affect the rate of vertigo subtypes.

Serum 25-Hidroksi D Vitamini ve Kalsiyum Seviyeleri ile İdiyopatik Benign Paroksismal Pozisyonel Vertigo Arasındaki İlişki

Amaç: Kliniğimize baş dönmesi şikâyeti ile başvurup idiopathic benign paroksismal pozisyonel vertigo (BPPV) tanısı alan hastalar ile baş dönmesi olmayan sağlıklı kontrol grubunun 25-hidroksi vitamin D (25-OH vitamin D) ve Ca2+ düzeylerinin karşılaştırılması Ca2+ ve 25-OH vitamin D’nin BPPV gelişimindeki rolünün araştırılmasıdır. Gereç ve Yöntem: Çalışmamız geriye dönük vaka kontrol çalışması olup, 01.01.2018-01.08.2021 arası Alanya Egitim ve Araştırma Hastanesi Nöroloji polikliniğine başvuran İdiopatik BPPV tanısı alan 409 hasta ile kontrol grubu olarak kliniğimize başvuru öncesi son 1 yıl içerisinde vertigo, dizziness ya da dengesizlik nedeniyle hekim başvurusu olmayan serum D vitamini düzeyi ölçümü yapılmış 338 hasta seçilerek oluşturuldu. İstatiksel değerlendirmeler için ki-kare ve T testi testi kullanıldı. Bulgular: Ortalama serum 25-OH vitamin D düzeyleri BPPV ve kontrol grubunda sırasıyla 15,74 ng/mL ve 17,91 ng/mL idi. Serum 25-OH vitamin D düzeyleri BPPV grubunda kontrol grubuna göre anlamlı derecede düşük bulundu ((p=0,01, p

The Relationship Between Disorders of Bone Metabolism and Benign Paroxysmal Positional Vertigo: A Systematic Review

OBJECTIVES

Several studies have reported an association between benign paroxysmal positional vertigo (BPPV) and bone mineral density or serum vitamin D levels. The aim of this review is to provide further clarification regarding the relationship between BPPV and calcium metabolism.

DESIGN

PubMed and MEDLINE databases were systematically reviewed to identify all English language papers regarding the relationship between BPPV and the following terms: osteoporosis, osteopenia, bone mineral density, serum vitamin D levels, and bone metabolism.

RESULTS

Of the 456 identified records, 28 studies were eligible for this review. Most were retrospective studies with inherent limitations and often conflicting results. While the literature is not conclusive, osteoporosis in patients of at least 50 years old appears to have an association with BPPV. Similarly, an association was observed between recurrent BPPV and vitamin D deficiency.

CONCLUSION

There is only weak evidence to support the relationship between BPPV and osteoporosis or low serum 25-hydroxyvitamin D levels. Further prospective studies with more robust methodologies are needed to clarify the association between BPPV and disorders of bone metabolism.

The role of low levels of vitamin D as a co-factor in the relapse of benign paroxysmal positional vertigo (BPPV)

BACKGROUND

Benign paroxysmal positional vertigo is characterized as brief episodes of vertigo that are exacerbated by the unexpected act of moving to a current provoking location. It is thought to be an otoconia-related balance disorder. Our objectives were to assess the serum concentrations of vitamin D and calcium (total and ionized) in cases with BPPV, determine if low vitamin D levels were regarded as a cause for BPPV relapse, and determine whether vitamin D supplementation would minimize the risk of BPPV relapse.

RESULTS

Sixty cases with BPPV were included in the study; 53 cases had posterior canal BPPV, while seven had lateral canal BPPV. Canalithiasis was the most common type of BPPV pathology. Forty cases had abnormally low levels of vitamin D. There was a statistically significant positive correlation between the mean vitamin D assay for all cases with BPPV and serum calcium. There was statistically significant difference in comparing the relapse of BPPV for group that receive vitamin D after one year follow up.

CONCLUSION

Abnormal vitamin D levels were linked with the incident and relapse of BPPV. Correction of low vitamin D levels was linked with the reduction of the relapse of BPPV.

Risk Factors for Recurrence of Benign Paroxysmal Positional Vertigo. A Clinical Review

Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular dysfunctions encountered in clinical practice. Although the treatment of BPPV is relatively successful, many patients develop recurrence after treatment. Our purpose is to evaluate the mean recurrence rate and risk factors of BPPV after treatment. A review of the literature on the risk factors of BPPV recurrence was performed. A thorough search was conducted using electronic databases, namely Pubmed, CINAHL, Academic Search Complete and Scopus for studies published from 2000 to 2020. Thirty studies were included in this review with 13,358 participants. The recurrence rate of BPPV ranged from 13.7% to 48% for studies with follow-up <1 year, and from 13.3% to 65% for studies with follow-up ≥2 years. Pathophysiologic mechanisms and implication of each of the following risk factors in the recurrence of BPPV were described: advanced age, female gender, Meniere’s disease, trauma, osteopenia or osteoporosis, vitamin D deficiency, diabetes mellitus, hypertension, hyperlipidemia, cardiovascular disease, migraine, bilateral/multicanal BPPV, cervical osteoarthrosis and sleep disorders. Patients with hyperlipidemia and hypertension had the highest recurrence rates of BPPV, 67.80% and 55.89%, respectively, indicating that vascular comorbidities increase the risk of BPPV recurrence. In addition, more than half of patients (53.48%) with diabetes mellitus and BPPV experienced recurrence of BPPV. Knowledge and awareness of risk factors for recurrence of BPPV are essential for the assessment and long-term prognosis of patients. Identification of these relapse risk factors may enhance the ability of clinicians to accurately counsel patients regarding BPPV and associated comorbidities.

Current and Emerging Medical Therapies for Dizziness

Medical therapies for dizziness are aimed at vertigo reduction, secondary symptom management, or the root cause of the pathologic process. Acute peripheral vertigo pharmacotherapies include antihistamines, calcium channel blockers, and benzodiazepines. Prophylactic pharmacotherapies vary between causes. For Meniere disease, betahistine and diuretics remain initial first-line oral options, whereas intratympanic steroids and intratympanic gentamicin are reserved for uncontrolled symptoms. For cerebellar dizziness and oculomotor disorders, 4-aminopyridine may provide benefit. For vestibular migraine, persistent postural perceptual dizziness and mal de débarquement, treatment options overlap and include selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants and calcium channel blockers.

Relation between vitamin D deficiency and benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV) is the most common cause of positional vertigo. Vitamin D deficiency may be one of the causes of its development. To assess the relation between recurrent attacks BPPV and Vitamin D deficiency. A case control study in which 40 patients were clinically diagnosed as posterior canal BPPV, Serum 25(OH) D was measured at 1st visit. Patients were divided into two groups; group A (20 patients) received Vitamin D supplementation in addition to canal repositioning maneuver and group B (20 patients) treated by canal repositioning maneuver only. Follow up of all patients for 6 months, neuro-otological assessment was repeated and recurrent attacks were recorded. Serum vitamin D was repeated after 6 month. This study included 14 males and 26 females age ranged from 35 to 61 years, Average serum of 25 (OH) D at the first visit was (12.4 ± 2 ng/ml) for group A, and (12.2 ± 1.7 ng/ml) for group B, all patients had low serum level of 25(OH) D (below 20 ng/ml). Recurrent BPPV episodes, were significantly lower in group A than that of group B. There is a relation between BPPV recurrence and low serum Vitamin D.

Serum otolin-1 as a biomarker for benign paroxysmal positional vertigo: a case-control study

OBJECTIVES

This study aimed to evaluate serum otolin-1 levels in patients with benign paroxysmal positional vertigo and to compare these levels with healthy individuals.

METHOD

This was a case-control study. After obtaining institutional ethical committee clearance, the serum level of otolin-1 was calculated in adult individuals (18-75 years old) who were divided into group 1 (patients presenting with benign paroxysmal positional vertigo) and group 2 (healthy patients without benign paroxysmal positional vertigo as the control group). Data analysis was carried out to compare the serum levels in the cases and controls. A p-value less than 0.05 was considered significant.

RESULTS

A total of 70 age-matched individuals (cases, n = 40; controls, n = 30) were included in the study. The mean serum level of otolin-1 was 636.8 pg/ml (range, 259-981 pg/ml) in the group of patients with benign paroxysmal positional vertigo and 236.2 pg/ml (range, 189-370 pg/ml) in the control group. The difference was statistically significant (p = 0.0000).

CONCLUSION

The serum levels of otolin-1 in patients with benign paroxysmal positional vertigo are significantly higher compared with individuals without benign paroxysmal positional vertigo.

Benign paroxysmal positional vertigo and vestibular impairment among older adults with dizziness

OBJECTIVE

This article aimed to investigate older adults visiting a geriatric institution for a bone density measurement who reported dizziness on a daily or weekly basis (but who are not seeking care for dizziness), according to BPPV, vestibular function, walking abilities, and frequency of falls.

METHODS

Patients coming for a bone density measurement answered questions regarding occurrence of dizziness. Patients having dizziness on a daily or weekly basis were considered eligible for the study and invited for investigation at the Ear, Nose, and Throat clinic at Södra Älvsborg Hospital, Sweden. The patients answered questions about history of dizziness, medications, and comorbidities. They were also investigated for BPPV, vestibular deficits using the video head impulse test (vHIT), walking speed, Timed Up and Go test (TUG), and for perception of verticality and horizontality and Romberg test.

RESULTS

A total of 55 patients with dizziness were included. Fifteen (27%) were diagnosed with BPPV. Forty (73%) patients reported falling during the previous year, including 11 with BPPV. Dizziness when turning in bed was more common among patients with BPPV and increased the risk of BPPV 8-fold.

CONCLUSION

BPPV is common among older adults with dizziness, including among those not seeking medical care. It is important to identify older adults with BPPV and treat the condition since BPPV may contribute to falls. Asking about dizziness when turning in bed can help to distinguish patients with increased risk for BPPV and older adults with dizziness should be investigated for BPPV even when typical history is lacking. Level of evidence: 4.

The Association Between Serum Vitamin D Levels and Benign Paroxysmal Positional Vertigo

OBJECTIVE

This study aimed to evaluate the association between serum vitamin D levels and benign paroxysmal positional vertigo (BPPV).

PARTICIPANTS AND METHODS

This prospective study consisted of 137 participants. There were 69 participants in the BPPV group compared with 68 healthy participants. Blood samples from both groups were collected from all participants to assess serum vitamin D levels.

RESULTS

No significant difference in demographic data between BPPV and control groups. The results showed that the mean serum vitamin D levels in the BPPV group was lower than that of the control group (P value = .001). Among BPPV participants, there was no statistically significant difference between mean serum vitamin D levels of participants with recurrent BPPV, and that of newly diagnosed BPPV participants (P value = .313).

CONCLUSION

A statistically significant association between lower mean serum vitamin D levels in the BPPV group compared with that of the control group. Therefore, low serum vitamin D levels may be one of the risk factors for BPPV.

Investigation of Serum Calcium and 25-Hydroxy Vitamin D Levels in Benign Paroxysmal Positional Vertigo Patients

OBJECTIVE

Benign paroxysmal positional vertigo (BPPV) is characterized by recurrent attacks of vertigo caused by head movements. It occurs as a result of otoconia falling into the semicircular canal. Calcium and 25 hydroxyvitamin D [25(OH)D] metabolism in the inner ear play an important role in otoconia formation and degeneration. Our aim in this study was to investigate the relationship between 25(OH)D levels and BPPV.

METHODS

This retrospective, case-controlled study included 52 patients with posterior canal BPPV and 52 controls aged 18 to 80 years. Age, sex, serum calcium, corrected calcium, and 25(OH)D levels of the BPPV and control group were compared.

RESULTS

Twenty-three of the patients were male (44.2%) and 29 were female (55.8%). The average age was 55.6 years. The 25(OH)D level was 15.3 ng/mL in the BPPV group and 20.2 ng/mL in controls. There was no significant difference in 25(OH)D and albumin-corrected calcium values (P = .394; P = .084, respectively). In 80.7% of the BPPV group and 61.5% of the controls, 25(OH)D levels were 20 ng/mL and below. 25 hydroxyvitamin D deficiency was found statistically significantly more frequently in patients with BPPV (P = .030).

CONCLUSION

In our study, serum 25(OH)D levels were found to be lower in patients with BPPV, and the rate of vitamin D deficiency was higher in these patients. Based on these results, it is recommended to examine the 25(OH)D levels of patients with BPPV at the time of diagnosis.

Relationship between calcium metabolism and benign paroxysmal positional vertigo in north Sardinia population

BACKGROUND

Benign paroxysmal positional vertigo (BPPV) has a reported recurrence ranging from 26.8 to 50%. Osteoporosis and Vitamin D deficiency seems to have an impact on recurrence of BPPV.

OBJECTIVE

to evaluate the impact of osteoporosis and Vitamin D deficiency on recurrence of BPPV.

METHODS

73 consecutive patients were divided in two groups according to the presence (group 1) or absence (group 0) of a recurrent episode. BMD, femoral and lumbar T-scores and Vitamin D levels were recorded. Statistical analysis was performed to investigate correlations.

RESULTS

patients in group 1 had statistically significant lower values of both femoral (-1,62±1,06 vs. -0,53±1,51; p = 0,001), lumbar T-score (-2,10±1,19 vs -0, 53±1.51, p = 0.001) and Vitamin D (19.53±15.33). The values of femoral T-score and Vitamin D could be combined in a model able to properly classify 65.8% of the cases (p = 0.002) as isolated or recurrent BPPV, with high accuracy (AUC 0.710 [0.590 -0.830]).

CONCLUSION

present data show a probable correlation between osteoporosis and Vitamin D with recurrent BPPV.

Benign Paroxysmal Positional Vertigo Risk Factors Unique to Perimenopausal Women

Many investigations have found common occurrences of benign paroxysmal positional vertigo (BPPV) in women, and clinical experience has shown that BPPV can develop due to increased hormonal fluctuations, especially during menopause. Therefore, knowledge about neurochemicals and their involvement with BPPV is imperative for the management of neurological issues in women. This review will discuss appropriate gender-based considerations of BPPV based on experimental and clinical evidence. The studies describe 2 lines of evidence regarding the association of perimenopause in women and the development of BPPV: (1) experimental evidence: the existence of estrogen receptors in the inner ear, otoconial malformations in osteopenic/osteoporotic rats, changes in otoconin 90 caused by hormone replacement therapy, and impaired calcium absorption following estrogen deprivation corrected by estrogen replacement therapy and (2) clinical evidence: epidemiological aspects, osteoporosis and estrogen deficiency. Future studies are necessary to validate the effects of hormonal replacement therapy and phytoestrogen in women with recurrent BPPV.

Serum levels of superoxide dismutases in patients with benign paroxysmal positional vertigo

Objective: To investigate the possible role of superoxide dismutases (SODs) in the development of benign paroxysmal positional vertigo (BPPV) and recurrence events in a 1-year follow-up study.

Methods: This was a prospective one-center study. A total of 204 patients with BPPV and 120 age-and sex matched healthy subjects were included. The levels of SOD between patients and control cases were compared. The levels of SOD between posterior semicircular canal (PSC) and horizontal semicircular canal (HSC) were also compared. In the 1-year follow-up, recurrence events were confirmed. The influence of SOD levels on BPPV and recurrent BPPV were performed by binary logistic regression analysis.

Results: The serum levels of SOD in patients with BPPV were lower than in those control cases (P<0.001). Levels of SOD did not differ in patients with PSC and HSC (P=0.42). As a categorical variable, for per interquartile range (IQR) increment of serum level of SOD, the unadjusted and adjusted risks of BPPV would be decreased by 72% (with the odds ratio [OR] of 0.28 [95% confidence interval (CI): 0.21–0.37], P<0.001) and 43% (0.57 [0.42–0.69], P<0.001), respectively. Recurrent attacks of BPPV were reported in 50 patients (24.5%). Patients with recurrent BPPV had lower levels of SOD than in patients without (P<0.001). For per IQR increment of serum level of SOD, the unadjusted and adjusted risks of BPPV would be decreased by 51% (with the OR of 0.49 [95% CI: 0.36–0.68], P<0.001) and 24% (0.76 [0.60–0.83], P<0.001), respectively.

Conclusion: Reduced serum levels of SOD were associated with higher risk of BPPV and BPPV recurrence events.

Effect of Vitamin D Injection in Recurrent Benign Paroxysmal Positional Vertigo with Vitamin D Deficiency

Introduction  There have been reports indicating that patients with frequently recurring benign paroxysmal positional vertigo (BPPV) had vitamin D deficiency, and some studies indicated that the treatment of severe vitamin D deficiency is effective in the reduction of the recurrence of BPPV.

Objective  The purpose of the present study was to examine the effects of Vitamin D ₃ injection on recurrence among patients with a 10 ng/mL or lower 25-hydroxyvitamin D blood concentration diagnosed with BPPV.

Methods  Among 99 patients with idiopathic BPPV with vitamin D deficiency, 25 patients (case group) were submitted to 3 to 4 injections of 200,000 IU of vitamin D ₃ in the first year. In total, 50 patients in the control group were selected through frequency matching, with 25 patients in the case group. Age, gender, and type of BPPV are used in matching variables with 1:2 matched data. The subjects of the study group were followed up for 24 months.

Results  The differences in relapse rates between the case and the control groups were examined using the non-parametric Kruskal-Wallis test for k independent samples. With regard to the relapse rates of the entire case and control groups by period, from 0 to 6 months ( p  < 0.531), from 7 to 12 months ( p  < 1.000), and from 13 to 24 months ( p  < 0.711), and in the entire study period ( p  < 0.883) there were no statistically significant differences.

Conclusion  The present case-control study indicated that vitamin D ₃ injection had no significant effect on the recurrence of BPPV patients with vitamin D deficiency when age, gender, and type of BPPV were homogeneous between the two groups.

Association between serum vitamin D levels and benign paroxysmal positional vertigo: a systematic review and meta-analysis of observational studies

OBJECTIVE

Benign paroxysmal positional vertigo (BPPV) was the most common neuro-otological disorder manifests as recurrent positional vertigo, but its risk factors are elusive. Recent studies suggest that decreased Vitamin D level may be a risk factor, but the literature is inconsistent.

METHODS

The databases PubMed, Web of Science, Chinese National Knowledge Infrastructure, Wanfang, SinoMed, and Embase were systematically searched for studies on the association between BPPV and  serum Vitamin D levels published up to June 2019. Data from eligible studies were meta-analyzed using Stata 12.0.

RESULTS

A total of 18 studies were included in the analysis. Serum Vitamin D levels were significantly lower in individuals with BPPV than in controls (WMD - 2.46, 95% CI - 3.79 to - 1.12, p < 0.001). Subgroup analysis by geographical area showed that vitamin D level was significantly lower in BPPV than in controls in China (WMD - 3.27, 95% CI - 4.12 to - 2.43, p < 0.001), but not outside China (WMD - 0.90, 95% CI - 4.36 to 2.56, p = 0.611). Vitamin D levels were significantly lower in recurrent than non-recurrent BPPV across all countries in the sample (WMD 2.59, 95% CI 0.35-4.82, p = 0.023). Vitamin D deficiency emerged as an independent risk factor of BPPV (OR 1.998, 95% CI 1.400-2.851, p < 0.001).

CONCLUSION

The available evidence suggests that BPPV is associated with decreased levels of serum Vitamin D, and vitamin D deficiency was an independent risk factor for BPPV.

Benign Paroxysmal Positional Vertigo (BPPV) in Children and Adolescents: Clinical Features and Response to Therapy in 110 Pediatric Patients

OBJECTIVE

This study aimed to characterize the clinical features and outcomes of benign paroxysmal positional vertigo (BPPV) in the pediatric population.

STUDY DESIGN

Retrospective case review.

SETTING

Tertiary care center.

PATIENTS

One hundred ten patients, aged 5 to 19 years old, diagnosed with BPPV.

MAIN OUTCOME MEASURES

Patient demographics, comorbidities, canal involvement, response to treatment, and incidence of recurrence.

RESULTS

BPPV was diagnosed in 19.8% of patients seen for dizziness during the study period. Patient age ranged 5 to 19 years old (mean =13.4 ± 3.4 yr). Female:male ratio was 3:2. The most prevalent comorbidities were concussion (n = 42, 38.2%) and migraine disorders (n = 33, 30.0%). Average time to diagnosis from symptom onset was 178.2 ± 190.8 days. The posterior canal was most frequently affected (n = 80, 72.7%), followed by the lateral canal (n = 37, 33.6%) and superior canal (n = 21, 19.1%), and 36.4% (n = 40) of patients had multiple canals affected. Treatment requiring more than or equal to five maneuvers to achieve resolution was observed in 11.8% of cases (n = 13). Recurrence was observed in 18.2% of cases. A logistic regression analysis demonstrated that patients with vestibular migraine or benign paroxysmal vertigo of childhood had five times higher odds of recurrence of BPPV, p = 0.003, 95% [1.735, 15.342], than those who did not have either.

CONCLUSIONS

BPPV is a relatively common cause of dizziness in the pediatric population. Children and adolescents with BPPV can be successfully treated with repositioning maneuvers but may be at risk for treatment resistance and recurrence. Increased awareness of BPPV in pediatric patients may reduce delays in identification and treatment.

Barometric pressure and the incidence of benign paroxysmal positional vertigo

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.

Serum Vitamin D and Long-term Outcomes of Benign Paroxysmal Positional Vertigo

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.

Difference in Serum Levels of Vitamin D Between Canalolithiasis and Cupulolithiasis of the Horizontal Semicircular Canal in Benign Paroxysmal Positional Vertigo

Background and Purpose: In the horizontal canal benign paroxysmal positional vertigo (BPPV), cupulolithiasis shows apogeotropic direction changing nystagmus lasting more than 1 min, while canalolithiasis leads to geotropic direction changing nystagmus lasting < 1 min. The difference between cupulolithiasis and canalolithiasis is widely accepted to be the attachment of the displaced otoconia to the cupula of a semicircular canal. Several studies have shown a relationship between BPPV and vitamin D deficiency, but no studies have compared serum levels of vitamin D between canalolithiasis and cupulolithiasis patients. The purpose of this study was to clarify the difference in vitamin D serum level between canalolithiasis and cupulolithiasis of the horizontal canal.

Methods: This retrospective study included 20 and 15 patients with canalolithiasis and cupulolithiasis of the horizontal canal, respectively. Serum levels of 25-hydroxyvitamin D [25(OH)D] during the acute phase of BPPV were measured.

Results: The mean 25(OH)D serum level in patients with canalolithiasis and cupulolithiasis was 13.2 ± 1.4 and 20.4 ± 1.6 ng/mL, respectively, and the difference was statistically significant (p = 0.0014), also after adjusting for age and sex (p = 0.0351). Eighteen out of 20 (90%) and 5 of 15 (33%) patients were diagnosed with vitamin D deficiency in the canalolithiasis and cupulolithiasis groups, respectively, and this difference was also statistically significant (p = 0.0005).

Conclusion: We found that serum vitamin D level in patients with canalolithiasis was significantly lower than that in patients with cupulolithiasis of the horizontal canal.

Semicircular canal biomechanics in health and disease

The semicircular canals are responsible for sensing angular head motion in three-dimensional space and for providing neural inputs to the central nervous system (CNS) essential for agile mobility, stable vision, and autonomic control of the cardiovascular and other gravity-sensitive systems. Sensation relies on fluid mechanics within the labyrinth to selectively convert angular head acceleration into sensory hair bundle displacements in each of three inner ear sensory organs. Canal afferent neurons encode the direction and time course of head movements over a broad range of movement frequencies and amplitudes. Disorders altering canal mechanics result in pathological inputs to the CNS, often leading to debilitating symptoms. Vestibular disorders and conditions with mechanical substrates include benign paroxysmal positional nystagmus, direction-changing positional nystagmus, alcohol positional nystagmus, caloric nystagmus, Tullio phenomena, and others. Here, the mechanics of angular motion transduction and how it contributes to neural encoding by the semicircular canals is reviewed in both health and disease.

Low 25-hydroxyvitamin D levels in postmenopausal female patients with benign paroxysmal positional vertigo

OBJECTIVE

Several studies have reported the association of benign paroxysmal positional vertigo (BPPV) with vitamin D deficiency. This study aimed to evaluate serum 25-hydroxy vitamin D (25 (OH) D) levels in native Chinese postmenopausal women with de novo idiopathic BPPV and to investigate the possible relationship between the occurrence of BPPV and low 25 (OH) D levels.

METHODS

This retrospective study comprised of 85 postmenopausal women with de novo idiopathic BPPV and 80 age-matched healthy controls. All subjects had bone mineral density (BMD) and serum 25 (OH) D levels measurements recorded, and the results were compared.

RESULTS

The prevalence of reduced BMD (T score <-1.0) was significantly higher in female patients with BPPV than in healthy controls (71.8% vs. 51.2%, p = .004). The mean serum 25 (OH) D levels were also significantly lower in female patients with BPPV than in healthy controls (19.1 ± 5.2 vs. 22.5 ± 5.8, p < .001). The regression analyses demonstrated that vitamin D deficiency was associated with BPPV with an odds ratio of 2.1 (95% confidence interval = 1.1-3.1, p = .031).

CONCLUSION

Our study suggests that low 25 (OH) D may be a risk factor for BPPV in postmenopausal women.

Analysis of effect of 1α-hydroxyvitamin D3 on benign paroxysmal positional vertigo and risk factors

The purpose of this study was to investigate the curative effect of 1α-hydroxyvitamin D3 on the benign paroxysmal positional vertigo (BPPV). Fifty BPPV patients diagnosed in the ENT Department of Anzhen Hospital from October 2015 to December 2016 were randomly selected as the treatment group, and treated with 0.25 µg 1α-hydroxyvitamin D3 once per day, in addition to the routine diagnosis and treatment. Moreover, 50 BPPV patients in the same period were selected as the control group, and received the routine diagnosis and treatment. The detection results of bone mineral density (BMD) t-value, vitamin D3 and bone metabolic markers before and after treatment were compared, and statistical analysis was performed on the results. There were no differences in the general data between treatment group and control group. There were no statistically significant differences in the BMD and age distribution of males and females between treatment group and control group (P>0.05). The BMD of male BPPV patients in each age group in the treatment group was significantly increased after treatment, and the difference was statistically significant (P<0.05). Although the BMD of male BPPV patients in each age group in control group was somewhat increased after treatment, the difference was not statistically significant (P>0.05). The BMD of female BPPV patients in each age group in treatment group was increased after treatment, and the difference was statistically significant (P<0.05). Similarly, although the BMD of female BPPV patients in each age group in control group was somewhat increased after treatment, the difference was not statistically significant (P>0.05). The average BMD of female BPPV patients in each age group was significantly lower than that of male patients, and the difference was statistically significant (P<0.05) (Table II). The BMD t-value of patients in treatment group showed a decreasing trend with the increase of age (Fig. 1). The levels of 25-hydroxyvitamin D3 and bone metabolic markers in treatment group were significantly improved compared with those before treatment (P<0.05). Multivariate Logistic regression analysis was performed to identify whether the treatment of BPPV was effective or not as a dependent variable, and six items, including the sex (female), hypertension, diabetes mellitus, age (>50 years), 25-hydroxyvitamin D3 and osteopenia/osteoporosis, as the independent variables, and the results suggested that the level of 25-hydroxyvitamin D3 and osteopenia/osteoporosis are the clinical features of whether the BPPV treatment is effective (P<0.05). The results showed that the treatment of BPPV with 1α-hydroxyvitamin D3 can effectively improve the symptoms of patients, and the level of vitamin D3 and the occurrence of osteopenia/osteoporosis are the clinical indexes of whether the BPPV treatment is effective.