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Sharifi A, Steenerson KK, Alyono JC, Ghaffari ME, Zojaji M, Ghaedsharaf S, Salmani MH, Kouhi A. The effect of climate changes on incidence of benign paroxysmal positional vertigo; a systematic review with meta-analysis of 16144 patients. ENVIRONMENTAL RESEARCH 2024; 259:119551. [PMID: 38977157 DOI: 10.1016/j.envres.2024.119551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/09/2024] [Accepted: 07/02/2024] [Indexed: 07/10/2024]
Abstract
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).
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Affiliation(s)
- Alireza Sharifi
- Department of Otolaryngology Head and Neck Surgery, Amir A'lam Hospital, Tehran University of Medical Sciences, Tehran, Iran; Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kristen K Steenerson
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jennifer C Alyono
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Mohammad E Ghaffari
- Department of Epidemiology and Biostatistics, Faculty of Health, Qom University of Medical Sciences, Qom, Iran
| | - Mohaddeseh Zojaji
- Digestive Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad H Salmani
- Student Research Committee, Qom University of Medical Sciences, Qom, Iran
| | - Ali Kouhi
- Department of Otolaryngology Head and Neck Surgery, Amir A'lam Hospital, Tehran University of Medical Sciences, Tehran, Iran; Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Chua KWD, Huang X, Koh XH, Soh JFJY, Barrera VC, Anaikatti P, Jing D, Moh S, Yeo M, Yuen HW, Low D, Rosario BH. Randomized Controlled Trial Assessing Vitamin D's Role in Reducing BPPV Recurrence in Older Adults. Otolaryngol Head Neck Surg 2024. [PMID: 39194424 DOI: 10.1002/ohn.954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/30/2024] [Accepted: 08/10/2024] [Indexed: 08/29/2024]
Abstract
OBJECTIVE To determine if the recurrence rates of BPPV in older adults were lower in the vitamin D-treated group as compared to placebo groups. STUDY DESIGN Double-blinded randomized control placebo trial. SETTING A single-centre study. METHODS Double-blinded randomized controlled trial design with 12 months follow-up. Vitamin D3 deplete participants were randomized into treatment (Group A) or placebo groups (Group B). Treatment group received 13 weeks of 2000 IU vitamin D3 followed by 1000 IU for the next 13 weeks. Patients who were replete were allocated to a control group (Group C) for observation and follow up. All groups had dietary interventions for vitamin D3 and calcium. RESULTS Results showed an 87% reduction in recurrence rates of BPPV in the treatment group (Group A), with 0.75 fewer clinical episodes per 1 person-year as compared to placebo (Group B). Time to first recurrence was also significantly longer in Group A. There was no statistically significant difference between Group A and C in both recurrence rates and dizziness handicap scores. CONCLUSIONS This clinical trial has laid the foundation to expand the investigation of vitamin D as standard of care treatment in BPPV patients in future phase IIb and III studies. SUMMARY A reduction in BPPV episodes in older adults has implications on fall risk, as dizziness from BPPV may cause falls. With fewer BPPV episodes and longer time to recurrence, seniors may have better postural stability and hence reduced risk of falls. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Kenneth W De Chua
- Department of Otorhinolaryngology-Head and Neck Surgery, Changi General Hospital, Singapore
| | - Xiaoting Huang
- Department of Geriatric Medicine, Singapore General Hospital, Singapore
| | - Xuan H Koh
- Department of Health Service Research, Changi General Hospital, Singapore
| | - Joshua F J Y Soh
- Department of Occupational Health, Ministry of Home Affairs, Home Team Medical Service Division, Singapore
| | - Vivian C Barrera
- Department of Geriatric Medicine, Changi General Hospital, Singapore
| | | | - Deng Jing
- Department of Otorhinolaryngology-Head and Neck Surgery, Changi General Hospital, Singapore
| | - Shirlene Moh
- Department of Allied Health, Dietetics, Changi General Hospital, Singapore
| | - Miko Yeo
- Department of Allied Health, Dietetics, Changi General Hospital, Singapore
| | - Heng W Yuen
- Department of Otorhinolaryngology-Head and Neck Surgery, Changi General Hospital, Singapore
| | - David Low
- Department of Otorhinolaryngology-Head and Neck Surgery, Changi General Hospital, Singapore
| | - Barbara H Rosario
- Department of Geriatric Medicine, Changi General Hospital, Singapore
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Bener A, Erdoğan A, Üstündağ ÜV. The Impact of Serums Calcium 25-Hydroxy Vitamin D, Ferritin, Uric Acid, and Sleeping Disorders on Benign Paroxysmal Positional Vertigo Patients. Audiol Res 2024; 14:640-648. [PMID: 39051198 PMCID: PMC11270364 DOI: 10.3390/audiolres14040054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/17/2024] [Accepted: 06/22/2024] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVE This study's objective was to identify the factors and impact of serums calcium 25-Hydroxy vitamin D, ferritin, uric acid, and sleeping disorders on benign paroxysmal positional vertigo (BPPV) patients. METHODS This is a case and control design study. The consecutive patients' visits (age, older than 25 years) with idiopathic BPPV were recruited in the present study. For each patient, 3:1 sex and age-matched healthy people were assigned as the control. The study comprised 177 patients with BPPV and 656 controls. The study included biochemical, clinical, physical examinations, PSQI sleep quality, supine roll test, and Dix-Hallpike test for the diagnosis of all patients, and pure-tone audiometry (PTA) was used to assess hearing. Univariate and multivariate stepwise regression analyses were used for statistical analysis. RESULTS The study comprised 833 patients with 295 males (35.4%) and 538 females (64.6%) who were between 25 and 70 years old. Of a total of 833 participants, 177 were BPPV patients, and 656 subject were normal. The results shown that there were significant differences between the BPPV and the normal group in terms of BMI (p = 0.039), physical activity (p = 0.003), cigarette smoking (p = 0.035), nargile-waterpipe use (p < 0.001), diabetes (p < 0.001), hypertension (p < 0.001), congestive heart failure (CHF) (p < 0.001), neurology (p < 0.001), tinnitus (p < 0.001), dizziness (p < 0.001), headache (p < 0.001), vitamin D (p = 0.004), calcium (p = 0.004), magnesium (p < 0.001), potassium (p = 0.019), phosphorus (p < 0.001), haemoglobin (p < 0.001), serum glucose (p < 0.001), HbA1c (p < 0.001), triglyceride (p < 0.001), systolic BP (p = 0.004), diastolic BP (p = 0.008), and microalbuminuria (p = 0.005); ATP III metabolic syndrome (p = 0.038), IDF metabolic syndrome (p = 0.034), and poor sleep (p = 0.033). In terms of the type of BPPV, the posterior canal was the most commonly affected (n = 126, 71.2%), followed by the horizontal (n = 43, 24.3%) and anterior canal (n = 8, 4.5%). The analysis indicated that serum ferritin (p < 0.001), uric acid (p < 0.001), blood pressure (p < 0.001), dizziness (p < 0.001), cigarette-water-pipe smokers (p = 0.004), headaches/migraines (p = 0.005), calcium (p = 0.007), vitamin D deficiency (p = 0.008), sleepiness (p = 0.016), physical activity (p = 0.022), CHF (p = 0.024), and tinnitus (p = 0.025) were considered as risk predictors for BPPV. CONCLUSIONS The results revealed that the serum levels of vitamin D, ferritin, uric acid, and calcium are low among the study population and supplementation could be considered as prevention in BPPV patients.
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Affiliation(s)
- Abdulbari Bener
- Department of Biostatistics and Public Health, School of Medicine, Istanbul Medipol University, Istanbul 34810, Turkey
- Department of Evidence for Population Health Unit, School of Epidemiology and Health Sciences, The University of Manchester, Manchester M13 9PR, UK
| | - Ahmet Erdoğan
- Department of ENT, Medipol International School of Medicine, Istanbul Medipol University, Istanbul 34810, Turkey
| | - Ünsal Veli Üstündağ
- Department of Biochemistry, Medipol School of Medicine, Istanbul Medipol University, Istanbul 34810, Turkey
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Ren Y, Li J, Xia F. Assessment of vitamin D deficiency in recurrent BPPV patients: A cross-sectional study. Am J Otolaryngol 2024; 45:104212. [PMID: 38176205 DOI: 10.1016/j.amjoto.2023.104212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE This study aimed to investigate the vitamin D deficiency of patients with BPPV recurrence and to evaluate the differences of 25-hydroxy vitamin D (25(OH)D) and serum calcium levels among gender and age categories. METHODS This cross-sectional study enrolled patients with BPPV. The diagnosis of BPPV was based on positional nystagmus and vertigo induced by certain head positions (The Dix-Hallpike maneuver and head roll tests). All patients' age, serum 25(OH)D, calcium measurements and recurrence data were collected and analyzed. RESULTS The median of 25(OH)D was 15.32 (IQR 10.61, 20.90) ng/ml. The recurrent group showed lower 25(OH)D levels than that of non-recurrent group [13.28 (IQR 9.47, 17.57) ng/ml vs 16.21 (IQR 11.49, 21.13) ng/ml]. There were significant differences of 25(OH)D levels among age categories. The proportion of vitamin D deficiency in patients ≥60 years old was lower than that in the other two groups. CONCLUSION Our study suggested that BPPV patients had a decreased 25(OH)D level and a high incidence of vitamin D deficiency. The 25(OH)D level of recurrent BPPV patients was lower than that in non-recurrent ones. Among them, the elderly group (≥60 years) took the preponderance, which had the lowest incidence of vitamin D deficiency and the highest incidence of vitamin D sufficiency.
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Affiliation(s)
- Yuanyuan Ren
- Department of Otorhinolaryngology-Head & Neck Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jinlan Li
- Department of Otorhinolaryngology-Head & Neck Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Fei Xia
- Department of Otorhinolaryngology-Head & Neck Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
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Rhim G, Kim MJ. Vitamin D Supplementation and Recurrence of Benign Paroxysmal Positional Vertigo. Nutrients 2024; 16:689. [PMID: 38474817 DOI: 10.3390/nu16050689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
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.
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Affiliation(s)
- Guil Rhim
- Department of Otorhinolaryngology, One Otorhinolaryngology Clinic, Paju 10924, Republic of Korea
| | - Moon-Jung Kim
- Department of Laboratory Medicine, Konyang University College of Medicine, Daejeon 35365, Republic of Korea
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Kong TH, Jung SY, Seo YJ, Shim DB. Vitamin D supplementation in preventing the recurrence of benign paroxysmal positional vertigo. Laryngoscope Investig Otolaryngol 2024; 9:e1225. [PMID: 38384364 PMCID: PMC10880126 DOI: 10.1002/lio2.1225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/06/2023] [Accepted: 02/03/2024] [Indexed: 02/23/2024] Open
Abstract
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.
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Affiliation(s)
- Tae Hoon Kong
- Department of Otorhinolaryngology ‐ Head and Neck SurgeryYonsei University Wonju College of MedicineWonju‐siGangwon‐doKorea
- Department of Medical Informatics and StatisticsYonsei University Wonju College of MedicineWonju‐siGangwon‐doKorea
| | - Su Young Jung
- Department of Otorhinolaryngology, Myongji HospitalHanyang University College of MedicineWonju‐siGangwon‐doKorea
| | - Young Joon Seo
- Department of Otorhinolaryngology ‐ Head and Neck SurgeryYonsei University Wonju College of MedicineWonju‐siGangwon‐doKorea
- Department of Medical Informatics and StatisticsYonsei University Wonju College of MedicineWonju‐siGangwon‐doKorea
| | - Dae Bo Shim
- Department of Otorhinolaryngology, Myongji HospitalHanyang University College of MedicineWonju‐siGangwon‐doKorea
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Zach H, Retter D, Schmoeger M, Rommer P, Willinger U, Schwarz FK, Wiest G. Seasonality of benign paroxysmal positional vertigo : A retrospective study from Central Europe. Wien Klin Wochenschr 2024; 136:25-31. [PMID: 37405489 PMCID: PMC10776474 DOI: 10.1007/s00508-023-02237-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/30/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Although benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo in clinical practice, factors influencing the pathophysiology remain not fully understood. OBJECTIVE Here we aim to investigate possible seasonal influences on the occurrence of BPPV in Vienna, a city located in a Central European country with pronounced seasonal fluctuations. METHODS We retrospectively investigated data from 503 patients presenting with BPPV to the outpatient clinics of the Medical University of Vienna between 2007 and 2012. Analyses included age, gender, type of BPPV, seasonal assignment, as well as daylight hours and the temperature in Vienna at symptom onset. RESULTS Out of 503 patients (159 male, 344 female, ratio 1:2.2; mean age 60 ± 15.80 years), most patients presented with posterior (89.7%) and left-sided (43.1%) BPPV. There was a significant seasonal difference (χ2 p = 0.036) with the majority of symptoms occurring in winter seasons (n = 142), followed by springtime (n = 139). Symptom onset did not correlate with the average temperature (p = 0.24) but on the other hand very well with daylight hours (p < 0.05), which ranged from 8.4 h per day in December, to an average of 15.6 h in July. CONCLUSION Our results show a seasonal accumulation of BPPV during winter and springtime, which is in line with previous studies from other climatic zones, suggesting an association of this seasonality with varying vitamin D levels.
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Affiliation(s)
- Heidemarie Zach
- Neurotology Outpatient Clinic, Dept. of Neurology, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria
| | - David Retter
- Neurotology Outpatient Clinic, Dept. of Neurology, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria
| | - Michaela Schmoeger
- Neurotology Outpatient Clinic, Dept. of Neurology, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria
| | - Paulus Rommer
- Neurotology Outpatient Clinic, Dept. of Neurology, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria
| | - Ulrike Willinger
- Neurotology Outpatient Clinic, Dept. of Neurology, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria
| | - Felix K Schwarz
- Neurotology Outpatient Clinic, Dept. of Neurology, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria
| | - Gerald Wiest
- Neurotology Outpatient Clinic, Dept. of Neurology, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria.
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Basaran MM, Sahin L. Climatic variations and pollution on benign paroxysmal positional vertigo in Kars, Türkiye. ENVIRONMENTAL RESEARCH 2023; 237:116985. [PMID: 37625533 DOI: 10.1016/j.envres.2023.116985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 08/27/2023]
Abstract
Benign paroxysmal positional vertigo (BPPV) is the most common diagnosis for peripheral vertigo. Although pathophysiological mechanisms remain unclear, BPPV is mostly idiopathic and factors related to BPPV are still being investigated. Knowing these factors can contribute to the prevention and management of BPPV. In this study, we investigated the correlations between climatic variations, pollution, and BPPV retrospectively. 262 patients diagnosed with BPPV between 2019 and 2021 in Kars, Türkiye, were included in our study. Meteorological parameters were obtained from Turkish State Meteorological Service. Horizontal BPPV increased significantly with the humidity (p < 0.05). In addition, carbon monoxide levels significantly increased the potantial of BPPV (p < 0.05). Surprisingly, BPPV increased in the summertime and showed a significant relationship with humidity. We believe this change is related with the city-specific features as it is the coldest place in the country, emigrant province and crowded in the summer times.
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Affiliation(s)
- Mustafa Mert Basaran
- Department of Otorhinolaryngology, Kafkas University, Faculty of Medicine, Kars, 36000, Turkey.
| | - Levent Sahin
- Department of Emergency Medicine, Kafkas University, Faculty of Medicine, Kars, 36000, Turkey
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Behr E, Honaker JA. When Particle Repositioning Maneuvers Just Will Not Stick: Clinical Considerations for Persistent Benign Paroxysmal Positional Vertigo. Am J Audiol 2023; 32:674-682. [PMID: 36758204 DOI: 10.1044/2022_aja-22-00118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
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.
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Affiliation(s)
- Evalena Behr
- Section of Audiology, Head & Neck Institute, Cleveland Clinic, OH
| | - Julie A Honaker
- Section of Audiology, Head & Neck Institute, Cleveland Clinic, OH
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Ren YY, Wang YJ, Li JL, Liu M, Xia F. Low vitamin D and uric acid status in patients with benign paroxysmal positional vertigo. Sci Prog 2023; 106:368504231205397. [PMID: 37807761 PMCID: PMC10563478 DOI: 10.1177/00368504231205397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
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.
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Affiliation(s)
- Yuan-Yuan Ren
- Department of Otorhinolaryngology Head & Neck Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yan-Jun Wang
- Department of Otorhinolaryngology Head & Neck Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jin-Lan Li
- Department of Otorhinolaryngology Head & Neck Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Mo Liu
- Department of Otorhinolaryngology Head & Neck Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Fei Xia
- Department of Otorhinolaryngology Head & Neck Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Chauhan I, Sidhu J, Lal B, Dhadwal M, Azad R. Role of Serum Markers in Benign Paroxysmal Positional Vertigo: Are They Useful? Indian J Otolaryngol Head Neck Surg 2023; 75:1731-1736. [PMID: 37636810 PMCID: PMC10447778 DOI: 10.1007/s12070-023-03727-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/23/2023] [Indexed: 03/31/2023] Open
Abstract
Benign Paroxysmal Positional Vertigo is a peripheral labyrinthine disease and is one of the most common causes of dizziness in the general population. The proposed study was conducted in the Department of Otorhinolaryngology - Head and Neck Surgery at Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh for a period of one year. About 44 patients aged between 14 and 60 years who came out positive on Dix Hallpike test and were willing for study were included in case group, whereas 44 patients aged 14-60 years who came out negative on Dix Hallpike test and with no complaint of vertiginous feeling were included in control group. Cases and controls were subjected to blood investigations like complete hemogram, calcium, vitamin D and uric acid. The mean Vitamin D was found to be significantly less in Case group (27.90 ± 15.89) compared to the Control group (39.05 ± 21.15) while no significant difference in mean Serum Calcium was observed between the Case group (8.48 ± 1.28) and Control group (8.88 ± 1.25). Serum uric acid levels were also compared and no significant difference was found between Case group (4.12 ± 1.15) and the Control group (4.06 ± 0.95). Our study found that there is relation between low vitamin D levels and occurrence of BPPV. Which supports the hypothesis that supplementation of Vitamin D might be helpful in preventing the occurrence and more frequent recurrence of BPPV. However in our study no association was found between serum calcium and uric acid levels with BPPV.
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Affiliation(s)
- Ishan Chauhan
- Department of Otorhinolaryngology-Head and Neck Surgery, IGMC SHIMLA, Himachal Pradesh Shimla, India
| | - Jasmine Sidhu
- Department of Otorhinolaryngology-Head and Neck Surgery, IGMC SHIMLA, Himachal Pradesh Shimla, India
| | - Bhushan Lal
- Department of Otorhinolaryngology-Head and Neck Surgery, IGMC SHIMLA, Himachal Pradesh Shimla, India
| | - Madhuri Dhadwal
- Department of Otorhinolaryngology-Head and Neck Surgery, YSPGMC NAHAN, Himachal Pradesh Nahan, India
| | - Ramesh Azad
- Department of Otorhinolaryngology-Head and Neck Surgery, IGMC SHIMLA, Himachal Pradesh Shimla, India
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Wang A, Zhou G, Brodsky JR. Characteristics of Benign Paroxysmal Positional Vertigo in Young Children. Laryngoscope 2023; 133:694-699. [PMID: 35524589 DOI: 10.1002/lary.30172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/29/2022] [Accepted: 04/19/2022] [Indexed: 11/08/2022]
Abstract
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.
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Affiliation(s)
- Alicia Wang
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Guangwei Zhou
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Jacob R Brodsky
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
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Cobb LH, Bailey VO, Liu YF, Teixido MT, Rizk HG. Relationship of vitamin D levels with clinical presentation and recurrence of BPPV in a Southeastern United States institution. Auris Nasus Larynx 2023; 50:70-80. [PMID: 35659787 DOI: 10.1016/j.anl.2022.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To examine the relationship of 25hydroxyvitamin D serum levels with BPPV incidence and recurrence rates. METHODS A retrospective cross-sectional, case-controlled study with follow-up phone survey was performed on patients diagnosed with BPPV between 05/2017-05/2020, who had available 25hydroxyvitamin D serology. Patients were seen at a multidisciplinary, vestibular-focused, neurotology clinic at a tertiary referral center. Controls consisted of subjects from the National Health and Nutrition Examination Survey (NHANES), and a locoregional age, sex, and race-matched group of patients from our institution. RESULTS Our BPPV cohort consisted of 173 patients (mean age 66.2 ± 11.8 years), who were predominately female (75.7%) and Caucasian (76.3%). Almost all age subgroups (BPPV, NHANES, and locoregional groups) ≤60 years old had insufficient levels of vitamin D. However, the overall BPPV cohort had a significantly higher vitamin D level than the NHANES control (31.4 ± 16.5 v. 26.0 ± 11.2 ng/mL, d=0.474 [0.323, 0.626]). There was no significant difference when compared to the overall locoregional control (31.4 ± 20.5 ng/mL). Migraines were significantly correlated to increased BPPV recurrence rates on univariate (beta=0.927, p=0.037, 95% CI: [0.057, 1.798]) and multiple regression analyses (beta=0.231, 95% CI: [0.024, 2.029], p=0.045). Furthermore, patients with BPPV recurrences had significantly lower levels of vitamin D at initial presentation when compared to patients with no recurrences (29.0 ± 12.0 v. 37.6 ± 18.3 ng/mL, d=0.571[0.139,1.001]). CONCLUSION Many BPPV patients in our cohort had insufficient vitamin D levels, and patients with BPPV recurrences had insufficient and significantly lower vitamin D levels than those without. As a readily available and affordable supplement, vitamin D may be used as an adjunct treatment but prospective studies should be done to confirm if it can prevent or reduce recurrence.
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Affiliation(s)
- Leah H Cobb
- Department of Otolaryngology; Medical University of South Carolina, Charleston, SC, USA
| | - Victoria O Bailey
- Department of Otolaryngology; Medical University of South Carolina, Charleston, SC, USA
| | - Yuan F Liu
- Department of Otolaryngology, Head and Neck Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Michael T Teixido
- Department of Otolaryngology, University of Pennsylvania, Philadelphia, PA, USA
| | - Habib G Rizk
- Department of Otolaryngology; Medical University of South Carolina, Charleston, SC, USA.
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Correlation between serum vitamin D level and benign paroxysmal positional vertigo recurrence. Auris Nasus Larynx 2023:S0385-8146(23)00021-4. [PMID: 36697291 DOI: 10.1016/j.anl.2022.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 12/03/2022] [Accepted: 12/30/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Benign paroxysmal positional vertigo (BPPV) is the most common cause of dizziness in the general population. BPPV is known to be closely related to the serum vitamin D level. This study aimed to examine the relationship between serum vitamin D levels and BPPV recurrence. METHODS A retrospective chart review was conducted on 50 patients diagnosed with posterior and lateral canal BPPV. The diagnosis of BPPV was based on the finding of vertigo and nystagmus induced by certain head positions (The Dix-Hallpike maneuver and head roll tests). The patients were classified into BPPV recurrence (Group A) and non-recurrence groups (Group B). Otolith function was assessed by cervical vestibular evoked myogenic potential (cVEMP) and ocular vestibular evoked myogenic potential (oVEMP), and their association with vitamin D levels was evaluated. RESULTS There were 19 subjects in Group A and 31 in Group B. There were no significant differences in age, sex, cVEMP, and oVEMP between the two groups. The average vitamin D level was 12.9 ± 8.0 ng/mL for Group A and 19.2 ± 8.2 ng/mL for Group B, and the difference between the groups was significant (p = 0.011). In the receiver operating characteristic curve analysis for BPPV recurrence with the best sensitivity and specificity, the optimal cut-off value of total serum vitamin D was determined as 12.74 ng/mL. Furthermore, reclassifying the patients based on the cut-off value showed a significantly higher recurrence rate in the group with a lower serum vitamin D level (70.5% vs. 22.5%, p = 0.007). CONCLUSION This complex finding highlights the importance of measuring serum vitamin D levels to monitor and evaluate patients at risk of BPPV recurrence.
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Sharma K, Ojha T, Dabaria R, Chhabra B, Trivedi BB, Bansal M. Relation Between Posterior Canal Benign Paroxysmal Positional Vertigo and Vitamin D Deficiency. Indian J Otolaryngol Head Neck Surg 2022; 74:4405-4408. [PMID: 36742797 PMCID: PMC9895194 DOI: 10.1007/s12070-021-03070-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/27/2021] [Indexed: 02/07/2023] Open
Abstract
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.
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Affiliation(s)
- Kanika Sharma
- Department of ENT, Mahatma Gandhi Medical College & Hospital, Jaipur, Rajasthan India
| | - Tarun Ojha
- Department of ENT, Mahatma Gandhi Medical College & Hospital, Jaipur, Rajasthan India
| | - Rajendra Dabaria
- Department of ENT, Mahatma Gandhi Medical College & Hospital, Jaipur, Rajasthan India
| | - Biban Chhabra
- Department of ENT, Mahatma Gandhi Medical College & Hospital, Jaipur, Rajasthan India
| | | | - Monika Bansal
- Department of ENT, Mahatma Gandhi Medical College & Hospital, Jaipur, Rajasthan India
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Zhou F, Yu B, Luo J, Ma Y, Li J, Zhang T, Yu G. Global trends in the research on benign paroxysmal positional vertigo: A 20-year bibliometric and visualization analysis. Front Neurol 2022; 13:1046257. [PMID: 36324379 PMCID: PMC9618818 DOI: 10.3389/fneur.2022.1046257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/29/2022] [Indexed: 11/17/2022] Open
Abstract
Background Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vestibular vertigo. Although BPPV is benign, its underlying mechanisms are complicated, and patients diagnosed with BPPV are significantly affected by it in their daily lives. Hence, this study's purpose was to investigate global trends and frontiers in the field of BPPV. Methods We searched the research literature published from 2002 to 2021 on BPPV using two databases from the Web of Science Core Collection, and we conducted a bibliometric and visualization analysis. Bibliometric tools were used to perform co-authorship, co-citation, and co-occurrence analyses of countries or regions, institutions, authors, journals, keywords, and references. Results In all, 1,419 publications from 4,594 authors, 1,542 institutions, and 65 countries or regions with 71 subject categories were included in the study. The number of articles increased gradually from 2002 to 2021. Seoul National University, the University of Munich, and Osaka University were among the leading institutions with the most publications, while United States of America, South Korea, and China were the leading countries. JS Kim was the most prolific author, Otology & Neurotology was the most prolific journal, and Otorhinolaryngology was the most published subject category. The five most frequently occurring keywords were BPPV, vertigo, dizziness, nystagmus, and management and the top research hot spots were osteoporosis and vitamin D. Conclusion This study systematically analyzed trends in global scientific research on BPPV. The academic understanding of BPPV has improved significantly over the last two decades, with osteoporosis and vitamin D the two main research hot spots in the field of BPPV in recent years. These findings provide direction for current research to grasp the trends and research frontiers of current research.
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Affiliation(s)
- Fangwei Zhou
- Department of Otorhinolaryngology Head and Neck Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Bingxi Yu
- Department of Otolaryngology, Xingyi People's Hospital, Xingyi, China
| | - Jiali Luo
- Department of Development and Planning, Guizhou Medical University, Guiyang, China
| | - Yifei Ma
- Department of Otorhinolaryngology Head and Neck Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jianyao Li
- Department of Otorhinolaryngology Head and Neck Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Tian Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China
- *Correspondence: Tian Zhang
| | - Guodong Yu
- Department of Otorhinolaryngology Head and Neck Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China
- Guodong Yu
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Prevention of Recurrent Benign Paroxysmal Positional Vertigo: The Role of Combined Supplementation with Vitamin D and Antioxidants. Audiol Res 2022; 12:445-456. [PMID: 36004953 PMCID: PMC9404917 DOI: 10.3390/audiolres12040045] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022] Open
Abstract
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.
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Vitamin D Supplementation for Benign Paroxysmal Positional Vertigo: A Systematic Review. Otol Neurotol 2022; 43:e704-e711. [PMID: 35878631 DOI: 10.1097/mao.0000000000003586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Benign paroxysmal positional vertigo (BPPV) is commonly attributed to displaced otoconia. These have been shown to have biomineralization close to that of bone, and vitamin D deficiency has been associated with BPPV. We aim to systematically review the available literature on vitamin D supplementation and BPPV intensity and recurrence in adults. DATABASES REVIEWED PubMed, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Current Controlled Trials, and ClinicalTrials.gov. METHODS We systematically reviewed the available literature from 1947 to April 2020. The study protocol was registered in the PROSPERO database (trial registration: CRD42020183195). RESULTS A total of 179 abstracts were identified and screened by two independent reviewers. Based on inclusion and exclusion criteria, six studies were selected and subjected to a quality assessment. In one randomized clinical trial (RCT), vitamin D supplementation was found to reduce annual recurrence rate of vertigo in patient with BPPV and subnormal serum vitamin D levels compared with placebo (odds ratio, 0.69; 95% confidence interval, 0.54-0.90). Non-RCTs demonstrated the possibility of a null effect in the random effects model (odds ratio, 0.08; 95% confidence interval, 0.00-1.56). The RCT considered as low risk of bias. All of the nonrandomized studies were assessed as serious risk of bias. CONCLUSIONS The intervention studies identified consistently demonstrated a decrease in BPPV recurrence with supplementation of vitamin D in patients with subnormal vitamin D levels. Although there is a paucity of high-quality studies, the present literature does highlight a role for optimization of vitamin D levels in patients with BPPV.
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Seyed Resuli A, Bedir A, Özgür A. The Relationship Between Benign Paroxysmal Positional Vertigo and Vitamin D. Cureus 2022; 14:e26068. [PMID: 35747111 PMCID: PMC9209340 DOI: 10.7759/cureus.26068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2022] [Indexed: 12/01/2022] Open
Abstract
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.
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Affiliation(s)
- Ali Seyed Resuli
- ENT, İstanbul Yeni Yüzyıl University, Faculty of Medicine, Gaziosmanpaşa Hastanesi, İstanbul, TUR
| | - Ahmet Bedir
- ENT, İstanbul Yeni Yüzyıl University, Faculty of Medicine, Gaziosmanpaşa Hastanesi, İstanbul, TUR
| | - Abdülkadir Özgür
- ENT, İstanbul Yeni Yüzyıl University, Faculty of Medicine, Gaziosmanpaşa Hastanesi, İstanbul, TUR
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ÖZŞİMŞEK A, KARAÇAY E. Serum 25-Hidroksi D Vitamini ve Kalsiyum Seviyeleri ile İdiyopatik Benign Paroksismal Pozisyonel Vertigo Arasındaki İlişki. ACTA MEDICA ALANYA 2022. [DOI: 10.30565/medalanya.1066381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
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
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Mancera Sánchez J, Hernaiz Leonardo JC, Ishiwara Niembro JK, Lesser JC. Therapeutic Effect of the Correction of Vitamin D Deficiency in Patients with Benign Paroxysmal Positional Vertigo – A Randomized Clinical Trial. Int Arch Otorhinolaryngol 2022; 26:e666-e670. [DOI: 10.1055/s-0041-1730992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 02/14/2021] [Indexed: 10/18/2022] Open
Abstract
Abstract
Introduction Benign paroxysmal positional vertigo (BPPV) appears during the same age group in which vitamin D and calcium deficiencies are evident. Vitamin D deficiency could predispose to BPPV, since these two entities share a demineralization process.
Objective To establish the otological impact of vitamin D supplementation in patients with its deficiency who suffer from BPPV.
Methods This was a randomized clinical trial. A total of 35 patients with vitamin D deficiency (< 30 ng/ml) and BPPV were divided into 2 groups: Group 1 (control group): treatment with repositioning maneuvers; and Group 2: treatment with repositioning maneuvers and vitamin D supplementation.
Results A follow-up of between 6 and 13 months and a log rank test revealed that the probability of recurrence between the experimental groups was significantly different, with group 2 having a decreased recurrence of vertigo (p = 0.17). Scores in the Dizziness Handicap inventory (DHI) in patients treated with vitamin D supplementation were smaller (10 ± 9) when compared with a score of 36 ± 9 in the control group.
Conclusion Plasmatic values of 25-hydroxyvitamin D have an impact in patients with BPPV, who present an improvement in their quality of life when their vitamin D levels are replaced with supplementation. Benign paroxysmal positional vertigo could stop being perceived as a purely otologic disease.
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Affiliation(s)
- Jimena Mancera Sánchez
- Ear Nose and Throat Department, Instituto Nacional de Rehabilitación, Mexico City, Mexico
| | | | - Julia Kioko Ishiwara Niembro
- Department of Otoneurology, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Juan Carlos Lesser
- Ear Nose and Throat Department, Instituto Nacional de Rehabilitación, Mexico City, Mexico
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22
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Safak AS, Bulut F, Cumbul A. Histopathological role of vitamin D deficiency in recurrent/chronic tonsillitis pathogenesis: Vascular epithelial growth factor-mediated angiogenesis in tonsil. Clin Exp Dent Res 2022; 8:699-706. [PMID: 35213796 PMCID: PMC9209805 DOI: 10.1002/cre2.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives Our aim in this study is to reveal the role of vitamin D deficiency in the pathogenesis of recurrent/chronic tonsillitis and to determine the expression of vascular epithelial growth factor (VEGF). Material and Methods This study was conducted between September and February. Thirty‐two patients between the ages of 3 and 35 (mean age 9.71) with recurrent episodes of chronic tonsillitis were selected. Patients were divided into four groups according to their 25OHD levels. Patients with 25OHD levels 0–10 ng/ml were determined as Group 1, 11–20 ng/ml Group 2, 21–30 ng/ml Group 3, and 31–50 ng/ml control Group 4. Routine histological tissue sampling was performed for histopathological evaluation of the tonsillar tissues under light microscope (LM). Five micron sections were taken from the paraffin blocks and stained with Hematoxylin Eosin (HE) and Trichrome Masson (TCM). VEGF expression was examined immunohistochemically for each group. Results Our analysis showed VEGF expression in all study groups (32 tonsillar tissues). Group 1 and Group 2 histopathological scores were significantly higher than the other groups (p < .001). There were significant differences in VEGF expressions between the four groups (p < .001). 25OHD levels of the patients in Groups 1 and 2 with strong VEGF expression were significantly lower than the other groups (p < .001). Conclusions In conclusion, this study showed an increased angiogenesis in tonsil and an increase in VEGF expression of the tonsillar surface epithelium when blood serum 25OHD levels <20 ng/ml.
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Affiliation(s)
- Ayse S Safak
- Department of Otorhinolaryngology, Istanbul Yeni Yüzyıl University, Özel Merkez Prime Hastanesi, Gebze, Turkey
| | - Fuat Bulut
- Department of Otorhinolaryngology, Private Corlu REYAP Hospital, Istanbul Rumeli University, Istanbul, Turkey
| | - Alev Cumbul
- Histology and Embryology, Istanbul Yeditepe University Faculty of Medicine, Istanbul, Turkey
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Libonati GA, Martellucci S, Castellucci A, Malara P. Minimum Stimulus Strategy: A step-by-step diagnostic approach to BPPV. J Neurol Sci 2022; 434:120158. [DOI: 10.1016/j.jns.2022.120158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/15/2021] [Accepted: 01/13/2022] [Indexed: 11/29/2022]
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Sideris G, Sapountzi MC, Malamas V, Korres G, Delides A, Nikolopoulos T. Climatic Variations as Indicators of Vitamin D Levels and Benign Paroxysmal Positional Vertigo. Cureus 2021; 13:e18811. [PMID: 34804669 PMCID: PMC8591250 DOI: 10.7759/cureus.18811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 11/05/2022] Open
Abstract
Objective To investigate the possible correlation between benign paroxysmal positional vertigo (BPPV), seasonality, and climatic variations as indicators of vitamin D deficiency, since otoconia are calcium carbonate crystals. Methods This is a study of patients who received the diagnosis of BPPV from September 2015 to August 2019. Gender, age, and month of diagnosis were factors recorded and analyzed. The cut-off age of 50 years is used to include osteoporotic patients and postmenopausal women. Meteorological and climatic data of latitude, temperature, sunshine hours, humidity, precipitation, wind force, atmospheric pressure, and horizontal solar irradiance were collected. Results Four hundred and eighty-five patients were included in the study; 206 were male (42%) and 279 were female (58%). The mean age was 57.8±15.4 and 54.9±13.9, respectively; 192 patients were ≤50 years old (121 female and 71 male) and 293 patients were over 50 years old (135 male and 158 female). A statistical significance in seasonal variation during autumn months was demonstrated (p-value= 5.2 e-05, z-statistic: 9.8164). There was no statistical correlation between the median number of BPPV patients and the median sunshine hours per month, horizontal solar irradiance, or other climatic variables. Conclusions Our study demonstrates seasonality in BPPV patients in Greece but no correlation between BPPV and climatic variations as a proxy for Vitamin-D levels was documented.
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Affiliation(s)
- Giorgos Sideris
- Second Ear-Nose-Throat Department, Attikon University Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Marilia C Sapountzi
- Second Ear-Nose-Throat Department, Attikon University Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | | | - George Korres
- Second Ear-Nose-Throat Department, Attikon University Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Alexander Delides
- Second Ear-Nose-Throat Department, Attikon University Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Thomas Nikolopoulos
- Second Ear-Nose-Throat Department, Attikon University Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
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Bedenko AS, Antonenko LM. Vitamin D deficiency in benign paroxysmal positional vertigo. CONSILIUM MEDICUM 2021. [DOI: 10.26442/20751753.2021.11.201141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim. To assess the level of vitamin D (D3) in patients with benign paroxysmal positional vertigo (BPPV).
Materials and methods. The study included 25 patients. The control group consisted of 30 people, comparable in age with the main group, without BPPV. All patients included in the study underwent a standard examination of the vestibular sphere, which compised the Head impulse test, the Fukuda test, the Shaking test, the DixHolpike and MacluraPagnini test. Hydroxyvitamin D levels were analyzed by enzyme immunoassay. In the study of the psychological sphere, the following questionnaires were used: Dizziness Handicap Inventory, Beck Depression Scale, SpielbergerKhanin Anxiety Scale, TAS-26 alexithymia scale.
Results. The average level of hydroxyvitamin D among patients was 19.658.6 ng/ml, which corresponds to a deficiency of vitamin D, in the control group, vitamin D3 was within the reference values (30100 ng/ml) and amounted to 33.7810.7 ng/ml (p0.001). There is a negative correlation between the level of hydroxyvitamin D and the age of the patients. There is a correlation (Spearman's criterion -0.463254, p0.001) between the frequency of recurrence of BPPV and a decrease in the level of hydroxyvitamin D.
Conclusion. Vitamin D deficiency prevails among patients with BPPV.
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Thomas RJ, Goutham MK, Bhat VS, Kamath SD, Aroor R, Bhandary SK. Association of Serum Calcium and Vitamin D with Benign Paroxysmal Positional Vertigo. Int Arch Otorhinolaryngol 2021; 26:e365-e369. [PMID: 35846804 PMCID: PMC9282954 DOI: 10.1055/s-0041-1724093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/21/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction
Benign paroxysmal positional vertigo (BPPV) is one of the common disorders of the peripheral vestibular system. The prevalence of BPPV is found to be higher among middle-aged women.
Objectives
To estimate the serum levels of calcium and vitamin D in patients with BPPV, and to study their association.
Methods
The present is a hospital-based prospective case-control study. Venous blood samples of the 49 patients with BPPV and an equal number of age- and gender-matched individuals were recruited and submitted to an analysis of the serum levels of calcium and vitamin D.
Results
Among the cases, 67.3% were found to be females, and 32.7% were males. Most of the 30 cases (61.3%) were aged > 40 years. The mean age of the cases was 44.39 years. The mean serum level of vitamin D in the cases was of 21.26 ng/ml compared with 17.59 ng/ml in the controls. The mean serum level of calcium was of 9.33 mg/dl in the cases, compared with 8.95 mg/dl in the controls. There was no significant difference in the serum levels of vitamin D and calcium between cases and controls.
Conclusion
We could not establish any correlation between the serum levels of calcium and vitamin D with BPPV. However, a negative relationship was found between the serum levels of vitamin D and the number of episodes of BPPV (
p
= 0.012).
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Affiliation(s)
- Ron Jacob Thomas
- Department of Otorhinolaryngology, K S Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, Karnataka, India
| | - M. K. Goutham
- Department of Otorhinolaryngology, K S Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, Karnataka, India
| | - Vadisha Srinivas Bhat
- Department of Otorhinolaryngology, K S Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, Karnataka, India
| | - Shrinath D. Kamath
- Department of Otorhinolaryngology, K S Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, Karnataka, India
| | - Rajeshwary Aroor
- Department of Otorhinolaryngology, K S Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, Karnataka, India
| | - Satheesh Kumar Bhandary
- Department of Otorhinolaryngology, K S Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, Karnataka, India
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The Relationship Between Disorders of Bone Metabolism and Benign Paroxysmal Positional Vertigo: A Systematic Review. Ear Hear 2021; 42:1462-1471. [PMID: 34010250 DOI: 10.1097/aud.0000000000001063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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28
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Elmoursy MM, Abbas AS. The role of low levels of vitamin D as a co-factor in the relapse of benign paroxysmal positional vertigo (BPPV). Am J Otolaryngol 2021; 42:103134. [PMID: 34166965 DOI: 10.1016/j.amjoto.2021.103134] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/12/2021] [Indexed: 12/01/2022]
Abstract
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.
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Affiliation(s)
| | - Awad Saad Abbas
- Rheumatology and Rehabilitation Department, Al-Azhar University, Assiut, Egypt
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29
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Abstract
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.
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Affiliation(s)
- Mallory J Raymond
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue MSC 550, 11th Floor, Charleston, SC 29425, USA
| | - Esther X Vivas
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, 550 Peachtree Street Northeast, 11th Floor, Atlanta, GA 30308, USA.
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30
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Abdelmaksoud AA, Fahim DFM, Bazeed SES, Alemam MF, Aref ZF. Relation between vitamin D deficiency and benign paroxysmal positional vertigo. Sci Rep 2021; 11:16855. [PMID: 34413436 PMCID: PMC8377140 DOI: 10.1038/s41598-021-96445-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 08/09/2021] [Indexed: 01/25/2023] Open
Abstract
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.
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Affiliation(s)
| | | | | | - Mohamed Farouk Alemam
- Clinical Pathology and Clinical Chemistry Department, South Valley University, Qena, Egypt
| | - Zaki Farouk Aref
- ENT Department, Faculty of Medicine, South Valley University, Qena, Egypt
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31
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Goldschagg N, Teupser D, Feil K, Strupp M. No evidence for a specific vitamin D deficit in benign paroxysmal positional vertigo. Eur J Neurol 2021; 28:3182-3186. [PMID: 34133827 DOI: 10.1111/ene.14980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The aim was to investigate whether there is a difference in serum 25-hydroxyvitamin D (25(OH)D) concentration between patients with benign paroxysmal positional vertigo (BPPV), patients with other vestibular diseases and patients with other neurological non-vestibular diseases presenting in a tertiary neurological academic outpatient clinic. METHODS The serum 25(OH)D concentration was measured in 680 patients (368 male, mean age ± SD 58 ± 17 years, 661 Caucasian) without vitamin D supplementation. 158 patients had BPPV; 221 had other vestibular diseases (including 122 with peripheral vestibular disorders, such as unilateral vestibulopathy or Ménière's disease; 46 with central vestibular disorders, such as vestibular migraine or cerebellar dizziness; 53 with functional dizziness); and 301 patients with other neurological non-vestibular diseases. RESULTS There was no significant difference in the serum 25(OH)D concentration between patients with BPPV (mean ± SD 23.4 ± 9.4 ng/ml) and those with other vestibular disorders (24.9 ± 10.1 ng/ml, p = 0.324). Patients with other neurological disorders had even lower concentrations (21.4 ± 10.6 ng/ml) than patients with BPPV (p < 0.005), patients with other vestibular disorders (p < 0.005) and all patients with vestibular disorders (24.9 ± 10.1 ng/ml, p < 0.005). CONCLUSION Our analysis does not support the theory of a specific relationship between serum 25(OH)D concentration and the occurrence of BPPV or other vestibular disorders.
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Affiliation(s)
- Nicolina Goldschagg
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany.,German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany
| | - Daniel Teupser
- Institute of Laboratory Medicine, University Hospital Munich, LMU Munich, Munich, Germany
| | - Katharina Feil
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany.,German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany.,Department of Neurology and Stroke, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Michael Strupp
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany.,German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany
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Zhang S, Xing J, Gong Y, Li P, Wang B, Xu L. Downregulation of VDR in benign paroxysmal positional vertigo patients inhibits otolith‑associated protein expression levels. Mol Med Rep 2021; 24:591. [PMID: 34165161 DOI: 10.3892/mmr.2021.12230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 11/04/2020] [Indexed: 11/06/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vertigo‑associated disease. Vitamin D (VD) helps maintain normal otolith function and may be associated with BPPV. VD exerts its biological functions primarily via the VD receptor (VDR). The present study demonstrated that serum VD levels were significantly decreased in patients with BPPV compared with in controls. VDR, otolith‑associated protein otoconin‑90 (OC90) and NADPH oxidase 3 (NOX3) expression levels were also significantly decreased in patients with BPPV compared with in controls. Furthermore, a positive correlation was observed between VD levels and VDR expression. Receiver operating characteristic curve analysis identified VDR expression levels as a potential diagnostic marker for BPPV. OC90 and NOX3 expression levels were notably lower in the inner ear tissue of VDR knockout mice compared with in those of wild‑type mice. In mice overexpressing VDR, OC90 and NOX3 were also overexpressed. Following intravenous injection of VD in VDR knockout mice, expression levels of OC90 and NOX3 were not significantly different from those in VDR knockout mice injected with saline. This indicated that VDR may be underexpressed in patients with BPPV and was associated with the expression levels of otolith‑associated proteins. Moreover, VDR mediated VD activation, leading to otolith protein formation. The present study provided a novel theoretical basis for BPPV onset that may facilitate the development of more effective diagnostic and treatment options.
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Affiliation(s)
- Shu Zhang
- Department of Otolaryngology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110, P.R. China
| | - Juanli Xing
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710048, P.R. China
| | - Yulin Gong
- Department of Rheumatic Immunology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110, P.R. China
| | - Ping Li
- Department of Obstetrics, Yongkang Maternal and Child Health Care Hospital, Yongkang, Zhejiang 321300, P.R. China
| | - Boqian Wang
- Department of Otolaryngology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110, P.R. China
| | - Ling Xu
- Department of Otolaryngology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010110, P.R. China
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33
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Yang Z, Li J, Zhu Z, He J, Wei X, Xie M. Effect of vitamin D supplementation on benign paroxysmal positional vertigo recurrence: A meta-analysis. Sci Prog 2021; 104:368504211024569. [PMID: 34128742 PMCID: PMC10455006 DOI: 10.1177/00368504211024569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Benign paroxysmal positional vertigo is characterized by recurrence, which exposes patients to repeated vertigo attacks. Vitamin D deficiency has been found to be a risk factor in benign paroxysmal positional vertigo, although effect of its elimination on recurrence reduction remains unknown. To determine the effect of vitamin D supplementation in preventing recurrence of benign paroxysmal positional vertigo patients with vitamin D deficiency using a meta-analysis study. We searched and retrieved relevant articles from several databases, then used the Cochrane evaluation system or Methodological Index for Non-Randomized Studies (MINORS) to assess the quality of studies. We adopted risk-ratio (RR) with corresponding 95% confidence interval (CI) to determine effect sizes, and further performed statistical analyses under a randomized- or fixed-effects model. Seven studies, comprising 602 and 731 participants in the case and control group respectively, met our inclusion criteria, and were therefore included in the meta-analysis. Assessment based on Cochrane evaluation system or MINORS revealed that most of the studies had high quality. Moreover, the randomized- model revealed that the vitamin D supplementation group had a lower recurrence rate than the control group which did not accepted vitamin D supplementation (RR = 0.41, 95% CI = 0.26-0.65, p < 0.01). Overall, these findings indicate that vitamin D supplementation can significantly lower recurrence in benign paroxysmal positional vertigo and vitamin D deficiency.
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Affiliation(s)
- Zhiling Yang
- Department of Otolaryngology Head and Neck Surgery, Gansu Provincial People’s Hospital, Lanzhou, China
| | - Juanli Li
- Department of Otolaryngology Head and Neck Surgery, Gansu Provincial People’s Hospital, Lanzhou, China
| | - Zhenzhen Zhu
- Department of Otolaryngology Head and Neck Surgery, Gansu Provincial People’s Hospital, Lanzhou, China
| | - Jian He
- Department of Otolaryngology Head and Neck Surgery, Gansu Provincial People’s Hospital, Lanzhou, China
| | - Xudong Wei
- Department of Otolaryngology Head and Neck Surgery, Gansu Provincial People’s Hospital, Lanzhou, China
| | - Min Xie
- Department of Neurosurgery, The First Hospital of Lanzhou University, Lanzhou, China
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Yadav H, Irugu D, Ramakrishanan L, Singh A, Abraham R, Sikka K, Thakar A, Verma H. An evaluation of serum Otolin-1 & Vitamin-D in benign paroxysmal positional vertigo. J Vestib Res 2021; 31:433-440. [PMID: 33720865 DOI: 10.3233/ves-201601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Serum otolin-1 is an inner ear protein exclusively expressed in otoconia and cells of vestibule and cochlea. Serum otolin-1 is found to be quantifiable in patients with BPPV. Low Vitamin-D is associated with pathogenesis of BPPV. Since otoconia degeneration contributes to BPPV, lack of Vitamin-D may impact otoconia structure and integrity. OBJECTIVE We aimed at studying the s.otolin-1 as biomarker and significance of vit-D in BPPV. MATERIAL AND METHOD 23 patients in test and control groups respectively were chosen within the age of 20 to 65 years. All the patients were diagnosed using Dix Hallpike menouver and head roll test, patients were treated with appropriate Canal Reposition Menouver (CRM). RESULTS Serum Otolin-1 levels among the test ranged from 366 to 882 pg/mL with mean of 585.17 pg/mL whereas in control group ranged from 223 to 462 pg/mL with mean of 335.26 pg/mL. Mean Vitamin-D levels among the test group was 22.67 ng/mL (Range = 6.3-68.4) and that of control 15.43 pg/mL (Range = 5.4-27.7) respectively. The relationship between the serum Otolin-1 and Vitamin-D was not statistically significant. CONCLUSION Otolin-1 levels is increased in BPPV patients and is sensitive in BPPV, specificity needs to be validated. Role of vitamin-D with respect to inner ear proteins needs further investigation.
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Affiliation(s)
- Harsha Yadav
- Junior Resident, Department of Otorhinolaryngology-Head & Neck surgery, AIIMS, New Delhi, India
| | - Dvk Irugu
- Associate Professor, Department of Otorhinolaryngology-Head & Neck surgery, AIIMS, New Delhi, India
| | | | - Archana Singh
- Associate Professor, Department of Biochemistry, AIIMS, New Delhi, India
| | - Ransi Abraham
- Senior Research Officer, Department of Cardiac Biochemistry, AIIMS, New Delhi, India
| | - Kapil Sikka
- Additional Professor, Department of Otorhinolaryngology-Head & Neck surgery, AIIMS, New Delhi, India
| | - Alok Thakar
- Professor & Head, Department of Otorhinolaryngology-Head & Neck surgery, AIIMS, New Delhi, India
| | - Hitesh Verma
- Associate Professor, Department of Otorhinolaryngology-Head & Neck surgery, AIIMS, New Delhi, India
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Jeong J, Eo TS, Oh J, Shin HA, Chung HJ, Choi HS. Monthly and seasonal variations in benign paroxysmal positional vertigo. J Vestib Res 2021; 31:101-107. [PMID: 33554929 DOI: 10.3233/ves-200030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Several studies on seasonal variation in benign paroxysmal positional vertigo (BPPV) have been reported. However, the association between season and BPPV remains controversial; thus, further study is required. OBJECTIVE We analyzed patients with BPPV to evaluate monthly and seasonal variations. METHODS Patients with BPPV seen between 2013 and 2017 were retrospectively enrolled in this study. Differences among the months and seasons of BPPV visits were analyzed. Patients were divided into two groups according to age (65 years or older and younger than 65 years) and sex, respectively, and the differences were analyzed in each group. RESULTS There was no significant difference in the monthly or seasonal distribution of BPPV in the 1,216 patients. There was also no significant difference in the monthly or seasonal distribution in the older and younger groups or in male and female patients. CONCLUSIONS There was no significant difference in the monthly or seasonal distribution of patients with BPPV. Additional studies on seasonal variation in BPPV are required in terms of not only vitamin D levels but also other associated factors.
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Affiliation(s)
- Junhui Jeong
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Tae Seong Eo
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jangwon Oh
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyang Ae Shin
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyo Jin Chung
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyun Seung Choi
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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36
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Sen JR, Tampio AJF, Cavanaugh SM, Nicholas BD. Use of Google Trends to evaluate for environmental variations in search terms for benign paroxysmal positional vertigo. Laryngoscope Investig Otolaryngol 2021; 6:145-149. [PMID: 33614943 PMCID: PMC7883612 DOI: 10.1002/lio2.512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/18/2020] [Accepted: 12/07/2020] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Climate variables are implied in the pathogenesis of certain otologic diseases, including benign paroxysmal positional vertigo (BPPV). Using internet search data obtained through Google Trends (GT), we explored the relationship between climate patterns and symptom search frequencies for BPPV. We hypothesized that increased latitude, as a proxy for decreased sunlight exposure, would lead to increase in BPPV symptom searches. METHODS GT searches for symptoms related to BPPV were obtained for five U.S. cities of different latitudes via the Google Trends online interface. Comparisons were made using SPSS via ANOVA analysis. Figures were made using Microsoft Excel. RESULTS Searches for BPPV-related symptoms increased with increasing latitude. BPPV-related symptoms did show seasonal variations, but not in predictable manners. CONCLUSIONS GT may be a viable research tool when comparing geographical differences in searches, but may be less sensitive in detecting time dependent changes. We offer suggestions as to how big data tools may be altered for research purposes. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Josh R. Sen
- Department of OtolaryngologySUNY Upstate Medical UniversitySyracuseNew YorkUSA
| | - Alex J. F. Tampio
- Department of OtolaryngologySUNY Upstate Medical UniversitySyracuseNew YorkUSA
| | | | - Brian D. Nicholas
- Department of OtolaryngologySUNY Upstate Medical UniversitySyracuseNew YorkUSA
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37
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Inan HC, Mertoğlu C, Erdur ZB. Investigation of Serum Calcium and 25-Hydroxy Vitamin D Levels in Benign Paroxysmal Positional Vertigo Patients. EAR, NOSE & THROAT JOURNAL 2021; 100:643-646. [PMID: 33491490 DOI: 10.1177/0145561321989451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Hakkı Caner Inan
- Department of Otorhinolaryngology, Erzincan University Medical Faculty, Erzincan, Turkey
| | - Cuma Mertoğlu
- Department of Medical Biochemistry, Erzincan University Medical Faculty, Erzincan, Turkey
| | - Zülküf Burak Erdur
- Department of Otorhinolaryngology, Kırklareli Training and Research Hospital, Kırklareli, Turkey
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38
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Melis A, Rizzo D, Gallus R, Leo ME, Turra N, Masnaghetti D, De Luca LM, Piras A, Bussu F. Relationship between calcium metabolism and benign paroxysmal positional vertigo in north Sardinia population. J Vestib Res 2020; 30:375-382. [PMID: 33285658 DOI: 10.3233/ves-200025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
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.
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Affiliation(s)
- Andrea Melis
- Azienda Ospedaliero Universitaria, Otolaryngology Division, Sassari, Italy
| | - Davide Rizzo
- Azienda Ospedaliero Universitaria, Otolaryngology Division, Sassari, Italy
| | | | - Maria Eleonora Leo
- Division of Otolaryngology, Department of Medical, Surgical and Experimental Science, University of Sassari, Sassari, Italy
| | - Nicola Turra
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | | | | | - Antonio Piras
- Azienda Ospedaliero Universitaria, Otolaryngology Division, Sassari, Italy
| | - Francesco Bussu
- Azienda Ospedaliero Universitaria, Otolaryngology Division, Sassari, Italy.,Division of Otolaryngology, Department of Medical, Surgical and Experimental Science, University of Sassari, Sassari, Italy
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Oh SR, Min SJ, Kim CE, Chang M, Mun SK. The effects of climate on the incidence of benign paroxysmal positional vertigo. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2020; 64:2119-2125. [PMID: 32829457 DOI: 10.1007/s00484-020-02002-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/04/2020] [Accepted: 08/18/2020] [Indexed: 06/11/2023]
Abstract
Benign paroxysmal positional vertigo (BPPV) is one of the most common vestibular disorders. An investigation into the factors related to BPPV could contribute to its prevention and appropriate management. We investigated the association between climatic factors and incidence of BPPV in this study. A total of 365 patients who were diagnosed with idiopathic BPPV in the emergency room of our hospital in 2015 were included. The number of patients diagnosed with BPPV per week was calculated (every week). Climatic factors, including daily average humidity, temperature, atmospheric pressure, cloud amount, sunshine amount, and daylight time, were documented daily. The weekly mean climatic value in each week was calculated. Simple correlation analysis and multivariate regression analyses were performed to identify climatic factors associated with the number of patients diagnosed with BPPV. Simple correlation analysis revealed a significant association between the humidity (r = 0.276, p = 0.048), temperature (r = 0.275, p = 0.049), and cloud amount (r = 0.293, p = 0.035) and the number of BPPV patients diagnosed per week. Multivariate regression analysis revealed that only the cloud amount was a statistically significant factor associated with the number of BPPV patients diagnosed every week. A significant positive association was discovered between the cloud amount and BPPV incidence. Cloud amount can therefore have an association with the incidence of BPPV.
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Affiliation(s)
- Seung Ri Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chung-Ang University, 102 Heukseok-ro, Dongjak-gu, Seoul, 156-755, Republic of Korea
| | - Sung Jin Min
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chung-Ang University, 102 Heukseok-ro, Dongjak-gu, Seoul, 156-755, Republic of Korea
| | - Chang Eurn Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chung-Ang University, 102 Heukseok-ro, Dongjak-gu, Seoul, 156-755, Republic of Korea
| | - Munyoung Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chung-Ang University, 102 Heukseok-ro, Dongjak-gu, Seoul, 156-755, Republic of Korea.
| | - Seog-Kyun Mun
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chung-Ang University, 102 Heukseok-ro, Dongjak-gu, Seoul, 156-755, Republic of Korea.
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Fu CY, Zhang ZZ, Chen J, Jaiswal SK, Yan FL. Unhealthy Lifestyle Is an Important Risk Factor of Idiopathic BPPV. Front Neurol 2020; 11:950. [PMID: 33178091 PMCID: PMC7593564 DOI: 10.3389/fneur.2020.00950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/22/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Benign paroxysmal positional vertigo (BPPV) is a self-limiting and recurrent disease but the cost is considerable. The number of patients with BPPV increased significantly under the quarantine policy in Hangzhou. The unhealthy lifestyle risk factors of BPPV have not yet been investigated. Thus, the objective is to analyze whether an unhealthy lifestyle is a risk factor of BPPV. Methods: One hundred and sixty three patients with idiopathic BPPV aged 22-87 years (BPPV group), and 89 aged 23-92 years sex-matched control subjects (non-BPPV group) were enrolled in this study. All BPPV patients received a definitive diagnosis which excluded secondary BPPV. Non-BPPV cases excluded BPPV, sudden deafness, Meniere's disease, ear or craniofacial surgery, vestibular neuritis, and head trauma history. We obtained a blood lipids profile, serum uric acid, total bilirubin, and related diagnostic information through the electronic medical record system. To get the time of physical activities and recumbent positions, we asked the patient or their family from February 2020 to June 2020, and the rest of the patient's information was acquired by phone or WeChat. Data Analyses: The t-test or chi-squared test, univariate, and multiple logistic regression analyses were performed for the two groups. For each factor, odds ratios were calculated with 95% confidence intervals (CIs). Moreover, test equality of two or more receiver operating characteristic (ROC) analyses were applied to the physical activities, and recumbent position time; area under curve (AUC) measures were calculated with 95% CIs and compared with each other. Results: The BPPV group had unhealthy lifestyles such as poor physical activities, prolonged recumbent position time, and low rate of calcium or VD supplementation in univariate logistic regression analyses (P < 0.05). Poor physical activities and prolonged recumbent position time were independently associated with BPPV in multiple logistic regression models (OR = 18.92, 95% CI: 6.34-56.43, p = 0.00 and OR = 1.15, 95% CI: 1.01-1.33, p < 0.04). In the comparison of ROC curves of recumbent position time and physical activities in identifying BPPV, AUCs were 0.68 (0.61-0.74), and 0.68 (0.63-0.73), respectively. Conclusion: We conclude that poor physical activities and prolonged recumbent position time may be independent risk factors for BPPV patients, but hypertension, hyperuricemia, hyperlipidemia, hemoglobin, diabetes, serum bilirubin, CHD, and CI, may not be.
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Affiliation(s)
- Chang-Yong Fu
- School of Medicine, Southeast University, Nanjing, China.,Neurology Department, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Zhen-Zhong Zhang
- Neurology Department, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Jin Chen
- School of Medicine, Southeast University, Nanjing, China
| | | | - Fu-Ling Yan
- Department of Neurology, Zhongda Hospital, Southeast University, Nanjing, China
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Jeong SH. Benign Paroxysmal Positional Vertigo Risk Factors Unique to Perimenopausal Women. Front Neurol 2020; 11:589605. [PMID: 33178127 PMCID: PMC7596253 DOI: 10.3389/fneur.2020.589605] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/17/2020] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Seong-Hae Jeong
- Department of Neurology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
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Kim SY, Kim HJ, Min C, Choi HG. Association between benign paroxysmal positional vertigo and osteoporosis: two nested case-control studies. Osteoporos Int 2020; 31:2017-2024. [PMID: 32483682 DOI: 10.1007/s00198-020-05478-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 05/25/2020] [Indexed: 12/11/2022]
Abstract
UNLABELLED Benign paroxysmal positional vertigo (BPPV) was related to a 1.28 times higher risk of osteoporosis. In addition, osteoporosis was associated with a 1.34 times higher risk of BPPV. This bidirectional relation was maintained after adjusting past medical histories and lifestyle factors, including obesity, smoking, and alcohol consumption. To our knowledge, this is the first study to explore the reciprocal association between BPPV and osteoporosis. In subgroup analyses, only women showed a reciprocal association between BPPV and osteoporosis. INTRODUCTION A previous population cohort study suggested an association between osteoporosis and benign paroxysmal positional vertigo (BPPV). This study aimed to investigate the bidirectional association between BPPV and osteoporosis. METHODS The Korean National Health Insurance Service-Health Screening Cohort data from 2002 to 2013 were used. In study I, the 50,897 osteoporosis patients were 1:1 matched with control I participants for age, sex, income, and region of residence. The previous histories of BPPV were analyzed in both groups using conditional logistic regression analysis. In study II, 9621 BPPV patients were 1:4 matched with control II participants. The previous histories of osteoporosis were analyzed in both groups using conditional logistic regression analysis. According to age and sex, subgroup analyses were achieved in both studies I and II. RESULTS A total of 1.6% (822/50,897) of osteoporosis patients and 1.3% (644/50,897) of control I participants had BPPV. The osteoporosis patients demonstrated a 1.28 times higher chance of developing BPPV (95% confidence intervals [95% CI] = 1.16-1.42, P < 0.001). In study II, 21.2% (2040/9621) of BPPV patients and 17.6% (6790/38,484) of control II participants had osteoporosis. The BPPV patients showed 1.34 times higher chance of having osteoporosis (95% CI = 1.26-1.43, P < 0.001). In the analysis of the women subgroup, these relations were reliable. CONCLUSION Osteoporosis patients had increased odds of having BPPV. On the other hand, BPPV patients had increased odds of having osteoporosis. This bidirectional relation was consistent only in the women subgroup.
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Affiliation(s)
- S Y Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - H-J Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, Republic of Korea
| | - C Min
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Republic of Korea
- Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - H G Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, Republic of Korea.
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Republic of Korea.
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Chen J, Zhang S, Cui K, Liu C. Risk factors for benign paroxysmal positional vertigo recurrence: a systematic review and meta-analysis. J Neurol 2020; 268:4117-4127. [DOI: 10.1007/s00415-020-10175-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/15/2020] [Accepted: 08/18/2020] [Indexed: 12/17/2022]
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Deng M, Liu C, Jiang W, Wang F, Zhou J, Wang D, Wang Y. A novel genetic variant associated with benign paroxysmal positional vertigo within the LOXL1. Mol Genet Genomic Med 2020; 8:e1469. [PMID: 32827243 PMCID: PMC7549573 DOI: 10.1002/mgg3.1469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 07/14/2020] [Accepted: 07/28/2020] [Indexed: 11/24/2022] Open
Abstract
Background Benign paroxysmal positional vertigo (BPPV) is a common, self‐limited, and favorable prognostic peripheral vestibular disorder. BPPV is transmitted in an autosomal dominant fashion, but most cases occur sporadically. Little research has been reported regarding the mutation spectrum of sporadic BPPV in a large cohort. This study attempted to identify the causative candidate variants associated with BPPV in VDR, LOXL1, and LOXL1‐AS1. Methods An amplicon‐targeted next‐generation sequencing (NGS) method for VDR, LOXL1, and LOXL1‐AS1, was completed in 726 BPPV patients and 502 normal controls. A total of 30 variants (20 variants from VDR, nine variants from LOXL1, seven variants from LOXL1‐AS1) were identified in these two groups. Results Three of 30 variants were nonsynonymous mutations, but no significant difference was found between the BPPV group and the control group via association analysis. A single nucleotide variant (SNV), rs1078967, was identified that is located in intron 1 of LOXL1. The allelic frequency distribution differed significantly between the BPPV group and the control group (p = 0.002). Genotypic frequency was also significantly different (p = 0.006), as determined by gene‐based analyses. Conclusion This report is the first to analyze the variant spectrum of BPPV in a large Chinese population.
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Affiliation(s)
- Mingzhu Deng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chen Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Weiqing Jiang
- Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fei Wang
- Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Juan Zhou
- Bio-X Institute, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Collaborative Innovation Center for Brain Science, Shanghai Jiao Tong University, Shanghai, China
| | - Dong Wang
- Bio-X Institute, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Collaborative Innovation Center for Brain Science, Shanghai Jiao Tong University, Shanghai, China
| | - Yonggang Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Headache Center, China National Clinical Research Center for Neurological Diseases, Beijing, China
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Li S, Wang Z, Liu Y, Cao J, Zheng H, Jing Y, Han L, Ma X, Xia R, Yu L. Risk Factors for the Recurrence of Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-Analysis. EAR, NOSE & THROAT JOURNAL 2020; 101:NP112-NP134. [PMID: 32776833 DOI: 10.1177/0145561320943362] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Benign paroxysmal positional vertigo (BPPV) has a high recurrence rate, but the risk factor-associated recurrence are elusive. METHODS Searches were performed in PubMed, Embase, Cochrane library, Web of science, Chinese National Knowledge Infrastructure, and Sino Med up to November 3, 2019. The effect size was analyzed by odds ratio and 95% CI. Data from eligible studies were meta-analyzed using Stata version 15.0. RESULTS Our search resulted in a total of 4076 hits. Twenty-four outcomes of sixty articles were included in the meta-analysis. Risk factors for the recurrence of BPPV included female gender, age (≥65years), hyperlipidemia, diabetes, hypertension, migraine, cervical spondylosis, osteopenia/osteoporosis, head trauma, otitis media, abnormal vestibular evoked myogenic potential, and long use of computers. No significant differences were found in side, type of the involved semicircular canals, smoking, alcohol consumption, stroke, ear surgery, duration of vertigo before treatment, the times of repositioning, Meniere disease, sleep disorders, hypercholesterolemia, and 25-hydroxy vitamin D. CONCLUSION These findings strengthen clinical awareness of early warning to identify patients with potential relapse risk of BPPV and clinicians should counsel patients regarding the importance of follow-up after diagnosis of BPPV.
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Affiliation(s)
- Shichang Li
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Zijing Wang
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Yan Liu
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Jie Cao
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Hongwei Zheng
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Yuanyuan Jing
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Lin Han
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Xin Ma
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Ruiming Xia
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Lisheng Yu
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
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Jeong SH, Kim JS, Kim HJ, Choi JY, Koo JW, Choi KD, Park JY, Lee SH, Choi SY, Oh SY, Yang TH, Park JH, Jung I, Ahn S, Kim S. Prevention of benign paroxysmal positional vertigo with vitamin D supplementation. Neurology 2020; 95:e1117-e1125. [DOI: 10.1212/wnl.0000000000010343] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 03/04/2020] [Indexed: 01/23/2023] Open
Abstract
ObjectiveTo assess the effect of vitamin D and calcium supplementation in preventing recurrences of benign paroxysmal positional vertigo (BPPV).MethodsWe performed an investigator-initiated, blinded-outcome assessor, parallel, multicenter, randomized controlled trial in 8 hospitals between December 2013 and May 2017. Patients with confirmed BPPV were randomly assigned to the intervention (n = 518) or the observation (n = 532) group after successful treatment with canalith repositioning maneuvers. The primary outcome was the annual recurrence rate (ARR). Patients in the intervention group had taken vitamin D 400 IU and 500 mg of calcium carbonate twice a day for 1 year when serum vitamin D level was lower than 20 ng/mL. Patients in the observation group were assigned to follow-ups without further vitamin D evaluation or supplementation.ResultsThe intervention group showed a reduction in the ARR (0.83 [95% confidence interval (CI), 0.74–0.92] vs 1.10 [95% CI, 1.00–1.19] recurrences per 1 person-year) with an incidence rate ratio of 0.76 (95% CI, 0.66–0.87, p < 0.001) and an absolute rate ratio of −0.27 (−0.40 to −0.14) from intention-to-treat analysis. The number needed to treat was 3.70 (95% CI, 2.50–7.14). The proportion of patients with recurrence was also lower in the intervention than in the observation group (37.8 vs 46.7%, p = 0.005).ConclusionsSupplementation of vitamin D and calcium may be considered in patients with frequent attacks of BPPV, especially when serum vitamin D is subnormal.Classification of evidenceThis study provides Class III evidence that for patients with BPPV, vitamin D and calcium supplementation reduces recurrences of BPPV.
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Cerebellar infarction presenting with isolated positional vertigo: differentiating factors for benign paroxysmal positional vertigo. Neurol Sci 2020; 42:1045-1052. [PMID: 32725450 DOI: 10.1007/s10072-020-04617-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 07/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Isolated central positional vertigo (CPV) due to cerebellar infarction is often difficult to differentiate from benign paroxysmal positional vertigo (BPPV). Here, we aimed to evaluate whether vascular risk factors and serum vitamin D level can differentiate between positional vertigo types. METHODS A total of 78 consecutive patients were consecutively enrolled from January 2017. All CPV patients had a National Institutes of Health Stroke Scale score of 0 and cerebellar infarctions confirmed by brain MR imaging. Vascular risk factors and serum 25-hydroxyvitamin D levels were compared between the two groups of patients. RESULTS The proportion of men was higher in the CPV than in the BPPV group (p = 0.004). Atrial fibrillation was common in the CPV group on univariate analysis (p = 0.046). However, there were no independent differentiating factors between the two groups. The proportion of patients according to the number of risk factors was significantly different between the two groups (linear by linear association test, p = 0.02). The mean serum 25-hydroxyvitamin D level did not differ. Also, the proportions of vitamin D insufficiency and deficiency did not differ significantly between the two groups. CONCLUSIONS Increased number of vascular risk factors including male sex suggested more CPV than BPPV. However, the serum vitamin D level was below the normal range in both groups. Our results demonstrate that serum vitamin D level has little value in the differential diagnosis of positional vertigo. Efforts to identify differentiating factors are warranted, and accumulating evidences including our research may lead to a diagnostic algorithm for isolated positional vertigo.
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Impaired Calcium Metabolism in Benign Paroxysmal Positional Vertigo: A Topical Review. J Neurol Phys Ther 2020; 43 Suppl 2:S37-S41. [PMID: 30883492 DOI: 10.1097/npt.0000000000000273] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Although acute attacks of benign paroxysmal positional vertigo (BPPV) may be treated with canalith repositioning maneuvers, there have been no well-designed prospective trials to prevent this highly prevalent and recurrent disorder. This topical review explores the evidence related to the association between deficient calcium metabolism and BPPV. We also describe the development of therapeutic options to prevent recurrences of BPPV and introduce results from a recent randomized controlled trial on the effect of vitamin D and calcium supplementation in preventing BPPV recurrences. SUMMARY OF KEY POINTS The literature describes 3 lines of evidence on association of impaired calcium metabolism and development of BPPV: (1) decreased bone mineral density was more frequently observed in persons with BPPV than in healthy controls; (2) estrogen plays a vital role in maintenance of otoconia, and estrogen deficiency appears to precipitate degeneration of otoconia and development of BPPV; and (3) lower serum vitamin D level is associated with development of BPPV, and supplementation of vitamin D and calcium carbonate may reduce further attacks of BPPV in persons with BPPV and subnormal serum vitamin D level. RECOMMENDATIONS FOR CLINICAL PRACTICE Restoration of impaired calcium metabolism with supplementation of vitamin D or estrogen should be considered in the treatment of individuals with frequent recurrences of BPPV. Future randomized controlled trials are mandatory to validate these supplementation therapies in individuals with recurrent BPPV.
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Chen J, Zhao W, Yue X, Zhang P. Risk Factors for the Occurrence of Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-Analysis. Front Neurol 2020; 11:506. [PMID: 32655479 PMCID: PMC7324663 DOI: 10.3389/fneur.2020.00506] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/07/2020] [Indexed: 01/05/2023] Open
Abstract
Background and Purpose: The lifetime prevalence of benign paroxysmal positional vertigo (BPPV) is high, especially in the elderly. Patients with BPPV are more susceptible to ischemic stroke, dementia, and fractures, severely reducing quality of life of patients. Many studies have analyzed risk factors for the occurrence of BPPV. However, the results of these studies are not identical. We performed this meta-analysis to determine potential risk factors associated with the occurrence of BPPV. Methods: PubMed, EMBASE, and the Cochrane Library (January 2000 through March 2020) were systematically searched for eligible studies analyzing risk factors for the occurrence of BPPV. Reference lists of eligible studies were also reviewed. We selected observational studies in English with a control group and sufficient data. Pooled odds ratios (ORs) or the mean differences (MDs) and 95% confidence intervals (CIs) were calculated to measure the impacts of all potential risk factors. Heterogeneity among studies was evaluated using the Q-test and I2 statistics. We used the random-effect model or the fixed-effect model according to the heterogeneity among the included studies. Results: We eventually included 19 studies published between 2006 and 2019, including 2,618 patients with BPPV and 11,668 participants without BPPV in total. In this meta-analysis, the occurrence of BPPV was significantly associated with female gender (OR = 1.18; 95% CI, 1.05–1.32; P = 0.004), serum vitamin D level (MD = −2.12; 95% CI, −3.85 to −0.38; P = 0.02), osteoporosis (OR = 2.49; 95% CI, 1.39–4.46; P = 0.002), migraine (OR = 4.40; 95% CI, 2.67–7.25; P < 0.00001), head trauma (OR = 3.42; 95% CI, 1.21–9.70; P = 0.02), and total cholesterol level (MD = 0.32; 95% CI, 0.02–0.62; P = 0.03). Conclusion: Female gender, vitamin D deficiency, osteoporosis, migraine, head trauma, and high TC level were risk factors for the occurrence of BPPV. However, the effects of other risk factors on BPPV occurrence need further investigations.
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Affiliation(s)
- Jinbao Chen
- Department of Pediatrics, The First Clinic College of Xinxiang Medical University, Xinxiang, China
| | - Weisong Zhao
- Department of Pediatrics, The First Clinic College of Xinxiang Medical University, Xinxiang, China
| | - Xuejing Yue
- School of Basic Medicine, Xinxiang Medical University, Xinxiang, China
| | - Ping Zhang
- Department of Neurology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
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D’Elia A, Quaranta N, Asprella Libonati G, Ralli G, Morelli A, Inchingolo F, Cialdella F, Martellucci S, Barbara F. The cochleo-vestibular secretory senescence. JOURNAL OF GERONTOLOGY AND GERIATRICS 2020. [DOI: 10.36150/2499-6564-485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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