Risk factors for benign paroxysmal positional vertigo recurrence: a systematic review and meta-analysis

The effect of climate changes on incidence of benign paroxysmal positional vertigo; a systematic review with meta-analysis of 16144 patients

BACKGROUND

There were controversial findings in terms of the association between the incidence of Benign Paroxysmal Positional Vertigo (BPPV) and climate changes, so the current systematic review plus meta-analysis is designed to discover this possible relationship.

METHODS

Web of science, PubMed, Scopus, Google Scholar, Embase, and Cochrane library were systematically searched up to August 2023. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Problem/Population, Intervention, Comparison, and Outcome (PICO) guidelines were used. Two authors independently reviewed the eligible articles and assessed the quality of them.

RESULTS

In total, 15 studies including 16144 patients met the inclusion criteria. Ten studies reported the relation of BPPV to monthly mean temperature, 7 to monthly average humidity, 4 to monthly average rainfall, 6 to monthly sunlight time, and 2 to average solar radiation. The incidence of BPPV was associated significantly with atmospheric pressure (P: 0.003) and rainfall (P: 0.017). However, there was not any statistically significant correlation between incidence of BPPV and humidity, sunlight time, temperature, and solar radiation level (P > 0.05).

CONCLUSIONS

The incidence of BPPV was higher in cold months of a year in both northern hemisphere and southern hemisphere countries. Although it can be because of negative correlation with temperature, the current meta-analysis did not find any statistically significant negative correlation with temperature. In addition, the incidence of BPPV was associated significantly with atmospheric pressure (positive correlation) and rainfall (negative correlation).

Anxiety characteristics in benign paroxysmal positional vertigo: first vs. recurrent episodes

PURPOSE

To assess the difference in state and trait anxiety levels in patients with Benign Paroxysmal Positional Vertigo (BPPV) at the first episode (FE) versus recurrent episodes (RE), before and after vestibular physiotherapy. A secondary objective was to assess the difference in the prevalence of underlying health conditions between FE and RE BPPV patients.

METHODS

Fifty-five patients with BPPV, aged 40-70, were recruited. The diagnosis of BPPV was confirmed based on subjective complaints of vertigo and positive results from the Dix-Hallpike and Supine Roll tests. Twenty-four patients were in their FE, and 31 had RE. All patients completed the State-Trait Anxiety Inventory (STAI) questionnaire three times; before, immediately after, and a week after vestibular physiotherapy treatment.

RESULTS

The RE group demonstrated higher trait anxiety than the FE group in all testing points: before treatment (median value of 38 versus 29, p-value = 0.02), immediately after treatment (median value of 36 versus 28, p-value < 0.01) and a week later (median value of 38 versus 28, p-value < 0.01). State anxiety decreased immediately after treatment in both groups, but at the second session, it was significantly higher in the RE than in the FE group (median value of 38 versus 28.5, p-value = 0.03). Hypothyroidism was significantly more frequent in the RE group (RE 16%, FE 0%, p-value = 0.04).

CONCLUSIONS

Based on the current study's findings, we recommend assessing anxiety levels in patients with recurrent BPPV and consider referring them for appropriate treatment when necessary.

Residual dizziness after BPPV management: exploring pathophysiology and treatment beyond canalith repositioning maneuvers

Despite the high success rate of canalith repositioning maneuvers (CRMs) in the treatment of benign paroxysmal positional vertigo (BPPV), a growing number of patients report residual dizziness symptoms that may last for a significant time. Although the majority of BPPV cases can be explained by canalolithiasis, the etiology is complex. Consideration of the individual patient's history and underlying pathophysiology of BPPV may offer the potential for treatment approaches supplementary to CRMs, as well as a promising alternative for patients in whom CRMs are contraindicated. This article provides a summary of the possible underlying causes of BPPV and residual dizziness, along with suggestions for potential management options that may be considered to relieve the burden of residual symptoms.

Clinical Outcomes in Patients With Benign Paroxysmal Positional Vertigo and Vitamin D Deficiency: A Singaporean Perspective

INTRODUCTION

Benign paroxysmal positional vertigo (BPPV) is the primary vestibular disorder causing peripheral vertigo. Given the role of vitamin D in maintaining otoconia homeostasis, its deficiency may elevate the risk of BPPV. Our study seeks to evaluate the correlation between vitamin D deficiency and clinical outcomes of patients with BPPV in the local Asian population.

METHODOLOGY

We performed a retrospective analysis of 149 consecutive adult patients referred to a tertiary center's Otolaryngology dizziness clinic between 2018 and 2021. All of these patients had both BPPV and vitamin D deficiency.

RESULTS

The mean serum vitamin D level was 19.4 ± 5.5 ng/mol. Approximately 51.7% (77/149) of patients experienced recurrent episodes of BPPV. Univariate Chi-square analyses demonstrated vitamin D levels (P < 0.001) and history of migraine (P = 0.04) were related to BPPV recurrence. On multivariate analyses, patients with higher serum vitamin D levels were 16.7% less likely to develop recurrent BPPV (odds ratio [OR] 0.83, 95% confidence interval [CI] 0.76-0.90, P < 0.001). However, migraine history was not significantly related to BPPV recurrence (OR 0.38, 95% CI 0.14-1.00, P = 0.050). There was no statistically significant difference in the duration of BPPV episodes based on vitamin D levels (P = 0.327).

CONCLUSIONS

Patients with vitamin D deficiency are at higher risk of recurrent BPPV. Future research directions that would be beneficial include conducting a randomized controlled trial to evaluate both the effectiveness of vitamin D supplementation and its optimal dosage.

Do single-session Epley maneuvers treat benign paroxysmal positional vertigo?

BACKGROUND

Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular condition characterized by short-term vertigo attacks that significantly affect quality of life.

OBJECTIVES

Examine how well a single Epley maneuver worked in an outpatient setting for people with posterior canal benign paroxysmal positional vertigo (PC-BPPV) and whether they needed a second Dix-Hallpike maneuver.

DESIGN

Prospective.

SETTINGS

Otorhinolaryngology department of a tertiary care center.

PATIENTS AND METHODS

Sociodemographic data, body mass index (BMI), and systemic disease history of 75 patients diagnosed with PC-BPPV were recorded, and their relationship with success rates after the modified Epley maneuver was analyzed.

MAIN OUTCOME MEASURES

Detect cases that could not be repositioned with the diagnostic control Dix-Hallpike test performed 20 minutes after the modified Epley reposition maneuver in the same session in PC-BPPV patients.

SAMPLE SIZE

75.

RESULTS

Of the 75 patients, 31 were male (41.3%), 44 female (58.6%) with a mean (standard deviation) age of 58.6 (15.9) years age, 54.6% had one or more chronic diseases. BMI was 30 mg/kg2 and above in 31 patients (41.3%). The modified Epley maneuver was successful in 77.3%. No significant relationship was found between additional diseases or BMI in the patient group in whom the maneuver was unsuccessful.

CONCLUSION

The success rates of repositioning maneuvers in treating patients diagnosed with PC-BPPV are high. However, more than a single maneuver is required in some resistant patients. Second diagnostic and repositioning maneuvers performed in the same session will reduce multiple hospital admissions. While it is helpful to repeat the maneuver in the patient group where it was unsuccessful, other factors causing the failure should be investigated.

LIMITATIONS

Lack of follow-up results of patients after 7-10 days.

Association between vitamin D deficiency and benign paroxysmal positional vertigo (BPPV) incidence and recurrence: a systematic review and meta-analysis

OBJECTIVES

The objective of this study is to determine the relationship between serum vitamin D level and the risk of developing benign paroxysmal positional vertigo (BPPV) incidence and recurrence in countries in the Northern Hemisphere.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed, Scopus and Web of Science databases were searched for studies published between January 2000 and February 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Participants located in the Northern Hemisphere aged 18 or over with at least one episode of BPPV, serum 25-hydroxyvitamin D levels measured and reported, no comorbidities or history of vitamin D supplementation.

DATA EXTRACTION AND SYNTHESIS

Data extraction and synthesis were performed by a single reviewer and checked by a second reviewer. Inclusion and exclusion criteria and risk of bias were assessed by two independent reviewers using the Newcastle Ottawa Tool for Cohort studies and Risk of Bias Assessment Tool for Nonrandomised Studies checklist for case-control studies. Meta-analysis was conducted using random effects models. Standard mean difference with a 95% CI was used to measure the relationship between vitamin D level and BPPV.

RESULTS

The 35 articles identified by the literature search reported data of 9843 individuals. 19 studies (7387 individuals) were included in the BPPV incidence meta-analysis while 7 studies (622 individuals) were included in the BPPV recurrence meta-analysis. Lower serum vitamin D levels were found in BPPV incidence compared with controls, but the relationship between vitamin D levels in recurrent BPPV compared with non-recurrent disease remained uncertain.

CONCLUSION

Results of this systematic review and meta-analysis demonstrated a negative correlation between serum vitamin D and BPPV incidence, while any relationship between serum vitamin D and BPPV recurrence remained uncertain. Risk of bias analysis revealed evidence of variable quality. There were insufficient data available to evaluate seasonal relationships between serum vitamin D and BPPV. Given the potential for this as a confounding factor, future research should aim to investigate this further.

PROSPERO REGISTRATION NUMBER

CRD42021271840.

No genetic causality between obesity and benign paroxysmal vertigo: A two-sample Mendelian randomization study

Objective

We applied Mendelian randomization to explore the causal relationship between obesity and benign paroxysmal vertigo (BPV).

Methods

We chose two types of obesity diseases. Obesity due to excessive calories and other or unspecified obesity from the FinnGen database. We used genomic significance (p < 5 × 10-8) to obtain independent single nucleotide polymorphisms (SNPs) as instrumental variables. Similarly, genome-wide association study data for the disease BPV were selected from the FinnGen database. R was then used to test the data for multiplicity and heterogeneity, as well as to detect the effect of individual SNPs on the results. Random effects inverse variance weighting was used as the main statistical analysis.

Results

First, by analyzing, we found an outlier in obesity due to excessive calories (rs12956821). Outliers were then removed, and the statistical results were analyzed without heterogeneity (p > 0.05) and horizontal pleiotropy (p > 0.05), as well as individual SNPs having no effect on the results. Meanwhile, random-effects IVW results showed obesity due to excessive calories (p = 0.481; OR = 0.941), and other or unspecified obesity (p = 0.640; OR = 0.964).

Conclusions

The present study did not find a causal relationship between the above two obesity types and BPV at the genetic level.

Early treatment for benign paroxysmal positional vertigo secondary to sudden sensorineural hearing loss

Sudden sensorineural hearing loss (SSNHL) accompanied by benign paroxysmal positional vertigo (BPPV) is relatively common in the clinic. There are unified standards for the treatment of primary BPPV with good reduction effect, while there are few studies on the treatment of BPPV secondary to SSNHL within 1 week of onset. The study was to investigate the treatment of BPPV secondary to SSNHL and compare its manual reduction with that of primary BPPV. We selected 90 patients with BPPV accompanied by SSNHL within a week of onset and 210 primary BPPV patients at Hebei Provincial Eye Hospital from June 2020 to December 2022. The former group was divided into the medicine group and manual reduction plus medicine group. The medicines used were extract of Ginkgo biloba leaves injection, betahistine hydrochloride injection and oral prednisone. We contrasted the efficacy respectively for posterior semicircular canal BPPV (psc-BPPV), horizontal semicircular canal BPPV (hsc-BPPV) and multiple semicircular canal BPPV (msc-BPPV). In addition, we compared the manual reduction effect for primary BPPV and manual reduction group, and the evaluation of efficacy are the intensity of nystagmus and the clinical symptoms. In the secondary BPPV group, there was no difference in efficacy between the medicine group and manual reduction group at the 7th-day after reduction for psc-BPPV, hsc-BPPV, and msc-BPPV (P > .05). The immediate effect of reduction was significantly different between the primary BPPV group and the group with SSNHL and BPPV for both psc-BPPV and hsc-BPPV (P < .05), and the effect of the primary BPPV group was better, but it was no difference for msc-BPPV (P > .05). For the treatment of BPPV accompanied by SSNHL within 1 week of onset, the additional reduction therapy showed no benefit, so we need to apply medication for SSNHL.

The role of electrocochleography and the caloric test in predicting short-term recurrence of benign paroxysmal positional vertigo

Objective

The study aimed to assess the value of physiological tests for evaluating inner ear function in predicting the short-term recurrence of benign paroxysmal positional vertigo (BPPV).

Materials and methods

The clinical information of all idiopathic BPPV patients who were treated in our clinic between February 2021 and December 2022 were reviewed. All patients included in the study had completed audiology examinations including pure tone audiometry, electrocochleography (EcochG), auditory brainstem response, and vestibular function examination such as the vestibular caloric test. The relationships between the results of the above tests and short-term recurrent BPPV were analyzed.

Results

A total of 96 patients with unilateral idiopathic BPPV were included for analysis. The numbers of non-recurrent patients and recurrent patients were 57 (59.4%) and 39 (40.6%), respectively. Only the results of EcochG and the caloric test showed significant differences between non-recurrent and recurrent patients (both P < 0.05). The results of these two tests were also found to be independently predictive of short-term recurrence (both P < 0.05). The non-recurrence rate for patients with normal results in both tests reached up to 78.3%, which was significantly higher than that for patients with abnormal results in both tests, 28.6% (P < 0.05).

Conclusion

Endolymphatic hydrops and canal paresis were independent risk factors for short-term recurrent BPPV. Additional treatments should be considered to reduce the recurrence rate, including dehydration treatment and vestibular rehabilitation.

Assessment of Osteoporosis and Vitamin D3 Deficiency in Patients with Idiopathic Benign Paroxysmal Positional Vertigo (BPPV)

Background and objectives: Osteoporosis and vitamin D3 deficiency may be risk factors of benign paroxysmal positional vertigo (BPPV). The aim of this study was to assess the prevalence of osteoporosis and 25(OH) vitamin D3 deficiency in a group of patients with idiopathic benign paroxysmal positional vertigo. Materials and Methods: Thirty-five patients (twenty-eight women and seven men) with posterior semicircular canal BPPV were enrolled in the study. The subjects underwent hearing assessment (tonal audiometry and impedance audiometry) and the Dix-Hallpike maneuver. Serum 25(OH) vitamin D3 levels were determined and lumbar spine bone densitometry was performed. The relationships between sex, age, height, Body Mass Index (BMI), vitamin D3 levels and bone densitometry results were assessed. Results: The diagnosis of osteoporosis was confirmed in 1 patient (3%), 3 subjects were osteopenic (8.6%), and normal bone densitometry was found in 31 (88.6%) patients. Conclusions: We found no statistically significant relationships between age, BMI or vitamin D3 levels and bone densitometry results in patients with idiopathic BPPV.

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.

Recurring benign paroxysmal positional vertigo after successful canalith repositioning manoeuvers

Benign baroxysmal positional vertigo (BPPV) represents the most common peripheral vestibular dysfunction encountered in clinical practice. Although canalith repositioning procedures (CRPs) are a relatively successful treatment for BPPV, many patients suffer from recurrences. Several studies have demonstrated that various pathological conditions (diabetes, hypertension, endolymphatic hydrops, low vitamin D levels) as well as delayed BPPV treatment using CRP, multiple canal involvement may be associated with recurrence of BPPV. We evaluated the history of 1,428 patients (558 males and 870 females, age range 10-92 years) suffering from BPPV. Of 1,428 cases, 820 (77%) did not relapse in the following 20 years. Mean age and gender did not differ significantly between groups with and without recurrence. Regarding risk factors for BPPV recurrence, age, female gender, migraine, hypertension, diabetes mellitus, hyperlipidaemia, osteoporosis, vascular diseases, and vitamin D deficiency may be associated with recurrent BPPV and should be kept in mind. Osteoporosis, vitamin D deficiency as well as thyroid dysfunction should be evaluated in postmenopausal women. Treatment of these comorbidities may help to reduce the risk of BPPV recurrence.

Efficacy of Epley's maneuver plus betahistine in the management of PC-BPPV: A systematic review and meta-analysis

BACKGROUND

To evaluate the efficacy of Epley's maneuver plus betahistine in the management of patients with posterior canal benign paroxysmal positional vertigo (PC-BPPV).

METHODS

Electronic databases including PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, and Wanfang were searched from their inception to April, 2022. The effect size was analyzed by calculating the pooled risk ratio estimates of efficacy rate, recurrence rate, and standardized mean differences (SMD) of dizziness handicap inventory (DHI) score with a 95% confidence interval (CI). Sensitive analysis was performed simultaneously.

RESULTS

A total of 9 randomized controlled trials with 860 PC-BPPV patients were included in the meta-analysis, in which 432 were treated with Epley's maneuver plus betahistine, and 428 received Epley's maneuver alone. The meta-analysis revealed that Epley's maneuver plus betahistine significantly improved DHI score than Epley's maneuver alone (SMD = -0.61, 95% CI -0.96 to -0.26, P = .001). In addition, both Epley's maneuver plus betahistine and Epley's maneuver groups had comparable outcomes in efficacy rate and recurrence rate.

CONCLUSION

This meta-analysis shows that Epley's maneuver plus betahistine in PC-BPPV patients had favorable effects on DHI score.

The relationship between psychological conditions and recurrence of benign paroxysmal positional vertigo: a retrospective cohort study

BACKGROUND

Psychological conditions have been found to be associated with an increased risk of incident benign paroxysmal positional vertigo (BPPV). However, much less is known on whether and how psychological conditions such as anxiety, insomnia and obsessive-compulsive disorder (OCD) affect the recurrence of BPPV.

METHODS

A retrospective cohort study of 2,612 outpatients and inpatients diagnosed with BPPV between September 2012 and August 2020. BPPV recurrence was followed up until February 2021. The Cox proportional hazard regression was used to analyze the association between psychological conditions and the risk of the first recurrence. Poisson regression was applied to analyze the association between psychological conditions and the number of recurrences in patients with at least one relapse.

RESULTS

During the follow-up, 391 patients had at least one BPPV recurrence. Female BPPV patients were more likely than male patients to experience relapses than male patients, but the characteristics of BPPV recurrence (number of recurrences and duration between recurrences) did not differ between men and women. After adjustment for sex, age and comorbidities, a heightened risk of first BPPV recurrence was found to be associated with anxiety (hazard ratio [HR]: 1.30, 95% confidence interval [CI]: 1.01, 1.68) and OCD (HR: 2.15, 95% CI: 1.31, 3.52). An increased risk of first BPPV recurrence associated with insomnia was only observed in male patients (HR: 2.22, 95% CI: 1.24, 3.98) but not in female patients (HR: 0.91, 95% CI: 0.63, 1.31). None of these psychological conditions were associated with the number of recurrences in patients who experienced recurrence.

CONCLUSIONS

The presence of anxiety and OCD increased the risk of first BPPV recurrence, as well as insomnia for male patients. These psychological conditions were not associated with the number of BPPV recurrences. Diagnosis and treatment of these psychological conditions could be a useful strategy to prevent the recurrence of BPPV.

Serum Vitamin D Concentration Is Lower in Patients with Tinnitus: A Meta-Analysis of Observational Studies

Background: Tinnitus is a highly prevalent and frequently disabling condition, such that the identification of possible causal mechanisms would yield significant clinical and social benefits. Since vitamin D (Vit D) is involved in the pathogenesis of several ear disturbances, we review here the current scientific literature addressing the relationship between Vit D status and tinnitus. Methods: An electronic search was conducted in PubMed, Scopus and Web of Science with the keywords “tinnitus” and “Vitamin D” or “Vit D” or “25OH-D” or “cholecalciferol” or “ergocalciferol” or “hydroxycholecalciferol”, without date (i.e., up to 8 February 2023) or language restrictions, in accordance with a protocol based on the transparent reporting of systematic reviews and meta-analysis (PRISMA) 2020 checklist, for identifying studies which assayed serum Vit D concentration in patients with or without tinnitus. Results: Three observational, case-control studies encompassing four cohorts and totaling 468 patients with (n = 268) or without tinnitus (n = 200) were included in this meta-analysis. Pooled analysis with quality effects models evidenced significantly reduced serum Vit D levels in patients with tinnitus compared to those without (weighted mean difference [WMD], −6.2 ng/mL; 95% CI, −10.3 to −2.1 ng/mL; I2, 56%). Serum Vit D was found to be 22% lower in patients with tinnitus compared to those without. Conclusions: Lower serum Vit D levels may be associated with tinnitus, thus paving the way to plan future trials aimed at exploring whether Vit D supplementation may aid in preventing and/or improving tinnitus.

Benign Paroxysmal Positional Vertigo Is Associated with an Increased Risk for Migraine Diagnosis: A Nationwide Population-Based Cohort Study

Previous studies reported an increased risk of benign paroxysmal positional vertigo (BPPV) in patients with migraine. Hence, we aimed to assess the risk of migraine in patients with BPPV. This cohort study was conducted using the Taiwan National Health Insurance Research Database. The BPPV cohort consisted of patients aged <45 years with a diagnosis of BPPV between 2000 and 2009. An age- and sex-matched comparison group free from a history of BPPV or migraine was selected. All cases were followed up from 1 January 2000 to 31 December 2010 or until death or a diagnosis of migraine. The baseline demographic characteristics in both groups were compared using Student's t-test and the chi-square test. Cox proportional hazards regression analysis was used to estimate the hazard ratio for migraine in the BPPV cohort compared with the comparison group after adjustment for age, sex, and comorbidities. Notably, 117 of the 1386 participants with BPPV and 146 of the 5544 participants without BPPV developed migraine. After adjustment for age, sex, and comorbidities, BPPV showed an adjusted hazard ratio indicating a 2.96-fold increased risk of migraine (95% confidence interval: 2.30-3.80, p < 0.001). We found that BPPV is associated with an increased risk of a migraine diagnosis.

The Prevalence of Symptom Reporting for Benign Paroxysmal Positional Vertigo in a Traumatic Brain Injury Population

OBJECTIVE

To assess the prevalence of benign paroxysmal positional vertigo (BPPV) in traumatic brain injury population.

STUDY DESIGN

In this cross-sectional design, each subject completed screening for BPPV, which included subjective questioning and positional testing. Subjects were asked if they experienced dizziness with bed mobility. All were tested with the Dix-Hallpike and the roll test to determine if nystagmus consistent with BPPV was present.

SETTING

Brain injury inpatient rehabilitation unit.

PARTICIPANTS

Subjects admitted to the rehabilitation unit during a 6-month time frame who had a traumatic mechanism of brain injury or experienced a fall resulting from a neurologic event.

INTERVENTIONS

Diagnostic interventions included the Dix-Hallpike and roll tests.

MAIN MEASURES

The primary outcomes of this study were the prevalence of BPPV and symptom reports.

RESULTS

Seventy-six subjects met the inclusion criteria. Three subjects were transferred to acute care before screening for BPPV could be completed. Of the 73 subjects who completed the screening process, 42 (58%) tested positive for BPPV, of which only 7 (10%) reported subjective symptoms of dizziness and/or vertigo. χ2 Analysis of the two screening methods demonstrated a statistically significant difference in the positivity rate between tests (χ21 = 5.715, p = 0.017, Cohen's W = 0.279). If subjects responded yes to both screening questions, they were significantly more likely to test positive for BPPV with a moderate effect size of 0.279.

CONCLUSION

There was a high prevalence of BPPV within an inpatient rehabilitation facility in subjects with traumatic brain injury, with a small percentage of patients reporting dizziness with subjective questioning.

Research progress on vestibular dysfunction and visual-spatial cognition in patients with Alzheimer's disease

Alzheimer's disease (AD) or vestibular dysfunction may impair visual-spatial cognitive function. Recent studies have shown that vestibular dysfunction is increasingly common in patients with AD, and patients with AD with vestibular impairment show more visual-spatial cognitive impairment. By exploring the relationship and interaction mechanism among the vestibular system, visual-spatial cognitive ability, and AD, this study aims to provide new insights for the screening, diagnosis, and rehabilitation intervention of patients with AD. In contrast, routine vestibular function tests are particularly important for understanding the vestibular function of patients with AD. The efficacy of vestibular function test as a tool for the early screening of patients with AD must also be further studied. Through the visual-spatial cognitive ability test, the "spatial impairment" subtype of patients with AD, which may be significant in caring for patients with AD to prevent loss and falls, can also be determined. Additionally, the visual-spatial cognitive ability test has great benefits in preventing and alleviating cognitive decline of patients with AD.

Association between otolin-1 and benign paroxysmal positional vertigo: A meta-analysis

Background

There is increasing research on the potential of inner ear proteins as serum biomarkers for the diagnosis and prognosis of various inner ear diseases. Among them, benign paroxysmal positional vertigo (BPPV) is the most common vestibular disease. Notably, otolin-1, an inner ear-specific protein, is detectable in the serum of most patients with BPPV patients. Therefore, we found a need to conduct this meta-analysis to determine the relationship between otolin-1 in serum and BPPV.

Methods

This meta-analysis was conducted by searching PubMed, EMBASE, Cochrane Library, Google Scholar, and China Network Knowledge Infrastructure databases for the eligible original studies in Chinese or English published between January 2010 and February 2022. Data were collected and pooled by using the mean differences (MDs) corresponding to 95% confidence intervals (CIs). Heterogeneity among these studies was assessed by using I² statistics and the adopted fixed or random-effect mode thereafter. Egger's and Begg's tests were also used to assess the publication bias.

Results

This meta-analysis included six articles with a total of 585 participants. Serum otolin-1 levels were remarkably increased in patients with BPPV as compared to that in healthy controls (MD: 165.38, 95% CI: 110.13-220.64, p < 0.00001). However, Egger's and Begg's tests have indicated no publication bias, and the results were reliable based on the sensitivity analysis.

Conclusion

This meta-analysis indicated that there is a higher serum level of otolin-1 in patients with BPPV than in healthy controls. Therefore, otolin-1 may serve as a biomarker for the onset of BPPV.

Association between Osteoporosis and Meniere's Disease: Two Longitudinal Follow-Up Cohort Studies

A high rate of Meniere's disease (MD) in patients with osteoporosis has been suggested. This research intended to estimate the bidirectional association of MD with osteoporosis. The ≥40-year-old population in the Korean National Health Insurance Service-Health Screening Cohort 2002-2019 was examined. In study I, 9529 patients with MD and 38,116 control I participants were analyzed for a previous history of osteoporosis. In study II, 65,858 patients with osteoporosis and 65,858 control II participants were analyzed for a previous history of MD. Stratified Cox proportional hazard models were applied to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) of MD for osteoporosis in study I and of osteoporosis for MD in study II. The rate of a prior history of osteoporosis was 13.3% for the MD group and 11.3% for the control I group. The patients with MD had a 1.12 times higher HR for previous osteoporosis (95% CI = 1.04-1.20). In study II, the rate or a prior history of MD was 3.7% for patients with osteoporosis and 2.0% for the control II group. The patients with osteoporosis had a 1.50 times higher HR for previous MD (95% CI = 1.40-1.61). Most subgroups according to age, sex, and comorbid conditions demonstrated consistent bidirectional associations between MD and osteoporosis. Adult patients with MD had a greater risk of osteoporosis. In addition, adult patients with osteoporosis also showed a higher risk of MD.

Benign paroxysmal positional vertigo with congenital nystagmus: A case report

BACKGROUND

Benign paroxysmal positional vertigo (BPPV) is a form of temporary vertigo induced by moving the head to a specific position. It is a self-limited, peripheral, vestibular disease and can be divided into primary and secondary forms. Congenital nystagmus (CN), an involuntary, rhythmic, binocular-symmetry, conjugated eye movement, is found at birth or within 3 mo of birth. According to the pathogenesis, CN can be divided into sensory-defect nystagmus and motor-defect nystagmus. The coexistence of BPPV and CN is rarely seen in the clinic.

CASE SUMMARY

A 62-year-old woman presented to our clinic complaining of a 15-d history of recurrent positional vertigo. The vertigo lasting less than 1 min occurred when she turned over, sometimes accompanied by nausea and vomiting. Both the patient and her father had CN. Her spontaneous nystagmus was horizontal to right; however, the gaze test revealed variable horizontal nystagmus with the same degree when the eyes moved. The patient’s Dix-Hallpike test was normal, except for persistent nystagmus, and the roll test showed severe variable horizontal nystagmus, which lasted for about 20 s in the same direction as her head movement to the right and left, although the right-side nystagmus was stronger than the left-side. Since these symptoms were accompanied by nausea, she was diagnosed with BPPV with CN and treated by manual reduction.

CONCLUSION

Though rare, if BPPV with CN is correctly identified and diagnosed, reduction treatment is comparably effective to other vertigo types.

Risk Factors of Residual Dizziness After Successful Treatment for Benign Paroxysmal Positional Vertigo in Middle-Aged and Older Adults

Objective

The purpose of this study was to analyze risk factors of residual dizziness (RD) after successful treatment for benign paroxysmal positional vertigo (BPPV) in middle-aged and older adults.

Methods

181 patients with BPPV, after successful canalith repositioning maneuver (CRM) treatment, were recruited. All patients were divided into the middle-aged group (aged 45–59 years, n = 101) and the older group (over 60 years, n = 80). The clinical characteristics were recorded, including age, gender, numbers of maneuvers, involved canal, affected side, RD, comorbidities, dizziness handicap inventory score, and generalized anxiety disorder's 7-item scale score.

Results

The incidence of RD in the older group was significantly higher than that of the middle-aged group (p = 0.033). Multivariate logistic regression analysis shows that age (odds ratio = 1.042, p = 0.006), moderate to severe dizziness (odds ratio = 2.017, p = 0.034), and moderate to severe anxiety (odds ratio = 2.228, p = 0.017) were independently associated with RD in middle-aged and older adults.

Conclusion

Older adults exhibited higher incidence of RD after successful treatment for BPPV. Age, moderate to severe dizziness, and moderate to severe anxiety were independent risk factors of RD in middle-aged and older adults.

Seven years of experience with treatment of benign paroxysmal positional vertigo with a mechanical rotational chair

Background

Throughout the last decade, several mechanical rotational chairs have been developed for diagnostics and treatment of patients with a typical case history of benign paroxysmal positional vertigo. Sparse evidence, however, exists in terms of diagnostic accuracy and treatment efficiency with these mechanical rotational chairs. Also, recommendations for optimal use of these chairs are yet to be determined.

Objective

Primary objective was to evaluate overall treatment of benign paroxysmal positional vertigo with a mechanical rotational chair and secondary objectives included description of patient- and BPPV characteristics, determination of subjective and objective outcomes, as well as analyzation of recurrence- and recurrence-related risk factors following successful treatment.

Methods

Retrospective cohort study with 635 patients diagnosed with benign paroxysmal positional vertigo and treated by means of a mechanical rotational chair during a 7-year period from 2014 to 2021 at a tertiary University hospital. Patient- and disease-specific characteristics, treatment and recurrence data were collected through reviewing of patient records.

Results

The mean number of required treatments was 2.7 when accounting for a six percent treatment failure rate (defined as a need of more than 10 treatments), and 3.7 when not. Bilateral mono-canal affection required 3.8 treatments, unilateral multi-canal 3.5 treatments, and the combination of bilateral and multi-canal affection 5.2 treatments. All these scenarios were associated with significantly higher numbers of required treatments when compared to unilateral mono-canal affection, which required 1.9 treatments. The overall recurrence rate was 25.4 percent.

Conclusion

A mechanical rotational chair provides successful treatment of benign paroxysmal positional vertigo. Mechanical rotational chairs should primarily be reserved for the treatment of retractable and atypical benign paroxysmal positional vertigo patients. Many aspects of the optimal use of these chairs still require elaborative assessment.

Association between Benign Paroxysmal Positional Vertigo and Previous Proton Pump Inhibitor Use: A Nested Case-Control Study Using a National Health Screening Cohort

The present nested case−control study evaluated the impact of previous proton pump inhibitor (PPI) prescription on the risk of benign paroxysmal positional vertigo (BPPV). A ≥40-year-old Korean population was included. A total of 34,441 patients with BPPV was matched with 137,764 comparison participants for demographic and socioeconomic factors. Previous histories of PPI use and PPI prescription dates were compared between the BPPV and comparison groups. The odds ratios (ORs) with 95% confidence intervals (CIs) of PPI use for BPPV were calculated using a logistic regression. The demographic and socioeconomic factors and comorbidities were adjusted in the adjusted model. Both current and past PPI users were associated with higher odds for BPPV than non-PPI users (adjusted OR (aOR) = 3.57, 95% CI = 3.33−3.83, and p < 0.001 for current PPI users and aOR = 1.76, 95% CI = 1.64−1.89, and p < 0.001 for past PPI users). In addition, longer dates of PPI use were related to higher odds for BPPV (aOR (95% CI) = 1.95 [1.81−2.10] for ≥1 day and <30 days of PPI prescription, <2.88 [2.68−3.10] for ≥30 days and <365 days of PPI prescription, and <3.45 [3.19−3.73] for ≥365 days of PPI prescription). PPI use was linked with an elevated risk of BPPV in the adult population. The odds for BPPV were higher in patients with a longer duration of PPI use.

High Serum Levels of Otolin-1 in Patients With Benign Paroxysmal Positional Vertigo Predict Recurrence

Background

Otolin-1 is an inner ear-specific protein that is exclusively expressed in otoconia and vestibule and cochlea cells. Recent investigations reported that otolin-1 can cross the blood-labyrinthine barrier and that the levels in serum well-reflected otolith status. Serum otolin-1 levels in patients with benign paroxysmal positional vertigo (BPPV) are significantly elevated compared with healthy controls. We aimed to explore whether otolin-1 can also serve as a biomarker for predicting BPPV recurrence.

Method

Patients at our institution with new-onset of idiopathic BPPV between May, 2017 and May, 2018 were recruited and followed up for 2 years. All demographic data of the patients were collected, and serum levels of otolin-1 and other laboratory indicators were measured and compared according to the recurrence status.

Results

A total of 74 patients, who met the inclusion criteria were enrolled in this study, of which 27 (36.5%) patients had suffered one or more episodes of recurrence after undergoing canal repositioning treatments during the study. The serum levels of otolin-1 in patients with recurrent BPPV were significantly higher than those in patients without recurrent BPPV (363.9 vs. 309.8 pg/ml, p = 0.001). In multivariate analysis comparing the second to fourth quartiles (Q2–Q4) against the first quartile (Q1) of otolin-1, the level of otolin-1 in Q4 could significantly predict BPPV recurrence, and the odds ratio (OR) was elevated by approximately 812% (OR = 9.12; 95% confidence interval [CI]: 1.44–57.9; p = 0.019).

Conclusion

High serum levels of otolin-1 were associated with an increased risk of BPPV recurrence, and further investigation is required to confirm this association and clarify the exact mechanism.

Vestibular Test Results in Patients With Horizontal Canal Benign Paroxysmal Positional Vertigo

Introduction

While the mechanism of posterior canal benign paroxysmal positional vertigo (BPPV) is widely accepted as canalolithiasis, the pathophysiology of horizontal canal BPPV remains controversial. We seek to analyze vestibular test results of patients with horizontal canal BPPV with ageotropic nystagmus (AHC) and geotropic nystagmus (GHC) in comparison to patients with posterior canal BPPV (PC) to better understand its pathophysiology.

Methods

In a retrospective chart review of adults with BPPV at a tertiary referral balance center, we reviewed the clinical characteristics and compared videonystagmography, caloric, rotary chair, subjective visual vertical (SVV)/ subjective visual horizontal (SVH), and vestibular evoked myogenic potential (VEMP) results between groups.

Results

We included 11 AHC and seven GHC patients and randomly selected 20 PC patients as the comparison group. All groups had a high rate of migraine and low rates of diabetes and head trauma, but no difference between groups. Ipsilateral caloric weakness was more prevalent in the GHC group compared to the PC group (p=0.02). One of two AHC patients and both GHC patients who had SVV/SVH testing had abnormal findings. The only AHC patient who had ocular VEMP testing had abnormal results. Additionally, we observed a significant downbeating component to nystagmus (4 deg/sec or greater) exclusively in the AHC group (5/10 patients, p=0.001).

Conclusions

Patients with AHC and GHC have unique vestibular testing results. In particular, only AHC patients showed a downbeating component to their nystagmus, which may suggest utricular dysfunction in the pathophysiology of AHC.

Nystagmus Parameters of Supine Roll Test Correlates With Prognosis After Repositioning Maneuver in Horizontal Semicircular Canal Benign Paroxysmal Positional Vertigo

Background: Positional nystagmus induced by supine roll test is characteristic for diagnosing horizontal semicircular canal benign paroxysmal positional vertigo (HC-BPPV). In this study, we aimed to explore the value of nystagmus parameters in by supine roll test (SRT) as prognostic factors in HC-BPPV.

Methods: We retrospectively analyzed the nystagmus parameters of 813 patients diagnosed with HC-BPPV by the SRT model in the SRM-IV system through video nystagmography. Then we used the computer-controlled canalith repositioning procedure (CCRP) mode for treatment. Based on the outcomes, patients were divided into either the cured group or the resistant group. The 1:1 propensity score matching (PSM) was applied to minimize potential selection bias. Then univariable and multivariable analyses were performed to identify the association of nystagmus parameters and the efficacy of CCRP.

Results: Among the 813 patients, 99 (12.2%) were classified in the resistant group. The right side of HC-BPPV patients was twice the number of the left side patients (537 vs. 276). PSM is used to pair resistant patients to the cured patients, in which 99 pairs were successfully matched. Results of univariate and multivariate analyses showed that patients in the resistant group have longer latency in the affected side [odds ratio (OR) = 1.231 (1.110–1.366); P < 0.001] and slower slow phase velocity (SPV) in the healthy side [OR = 0.957 (0.917–0.999); P = 0.045].

Conclusion: Nystagmus parameters may represent the characteristics of canalith. HC-BPPV patients with a longer latency in the affected side and slower SPV on the healthy side during SRT have a higher risk of HC-BPPV persisting after a single CCRP.

Characteristics of bone metabolism in postmenopausal female patients with different types of idiopathic benign paroxysmal positional vertigo: A single-centre retrospective study

OBJECTIVE

The association between benign paroxysmal positional vertigo (BPPV) and impaired calcium metabolism has attracted widespread interest. Several studies have suggested that decreased bone mineral density (BMD) and serum 25-hydroxyvitamin D (25(OH)D) level are related to the occurrence and/or recurrence of BPPV; however, the characteristics of bone metabolism in patients with BPPV subtypes have not been fully investigated, and conclusions have been controversial. This study aimed to evaluate BMD and serum levels of 25(OH)D and bone turnover markers to clarify the characteristics of bone metabolism in patients with different types of BPPV.

METHOD

We retrospectively analysed the data of new-onset idiopathic postmenopausal female patients with BPPV at our institution from January 2016 to January 2020. The patients' demographic data including age, medication history, concomitant diseases, onset time, clinical form, laboratory indicators, such as serum levels of 25(OH)D, bone formation markers, namely, amino-terminal propeptide of type I procollagen (PINP) and osteocalcin (OC), bone resorption marker, namely, β-isomerized carboxy-terminal telopeptide of type I collagen (β-CTX), and BMD were collected and analysed.

RESULTS

This study included 201 consecutive postmenopausal female patients with BPPV. Among them, 138 were diagnosed with posterior semicircular canal BPPV, 42 were diagnosed with lateral semicircular canal canalolithiasis, and 21 were diagnosed with lateral semicircular canal cupulolithiasis. There were no significant differences in age distribution, body mass index, clinical history, levels of albumin, globulin, uric acid, creatinine, or blood urea nitrogen, lipid profiles (except high-density lipoprotein cholesterol) and routine blood parameters among these groups (P > 0.05). There were no significant differences in the mean T-score and BMD values of different sites or in the serum levels of 25(OH)D and bone turnover markers (PINP, OC and β-CTX) among the subgroups (P > 0.05). The proportion of reduction in BMD (T-score < -1 SD) and decreased serum vitamin D level (< 20 ng/ml) were not significantly different between the subgroups (P > 0.05).

CONCLUSION

There were no significant differences in bone metabolism in postmenopausal female patients with different types of idiopathic 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.

No Impact of Stochastic Galvanic Vestibular Stimulation on Arterial Pressure and Heart Rate Variability in the Elderly Population

Objective

Noisy galvanic vestibular stimulation (nGVS) is often used to improve postural stability in disorders, such as neurorehabilitation montage. For the safe use of nGVS, we investigated whether arterial pressure (AP) and heart rate vary during static supine and slow whole-body tilt with random nGVS (0.4 mA, 0.1–640 Hz, gaussian distribution) in a healthy elderly population.

Methods

This study was conducted with a double-blind, sham-controlled, cross-over design. Seventeen healthy older adults were recruited. They were asked to maintain a static supine position on a bed for 10 min, and the bed was tilted up (TU) to 70 degrees within 30 s. After maintaining this position for 3 min, the bed was passively tilted down (TD) within 30 s. Real-nGVS or sham-nGVS was applied from 4 to 15 min. The time course of mean arterial pressure (MAP) and RR interval variability (RRIV) were analyzed to estimate the autonomic nervous activity.

Result

nGVS and/or time, including pre-/post-event (nGVS-start, TU, and TD), had no impact on MAP and RRIV-related parameters. Further, there was no evidence supporting the argument that nGVS induces pain, vertigo/dizziness, and uncomfortable feeling.

Conclusion

nGVS may not affect the AP and RRIV during static position and whole-body tilting or cause pain, vertigo/dizziness, and discomfort in the elderly.

Update on benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo worldwide. This review considers recent advances in the diagnosis and management of BPPV including the use of web-based technology and artificial intelligence as well as the evidence supporting the use of vitamin D supplements for patients with BPPV and subnormal serum vitamin D.