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Chu C, Chan YM, Tang J. Clinical Outcomes in Patients With Benign Paroxysmal Positional Vertigo and Vitamin D Deficiency: A Singaporean Perspective. Cureus 2024; 16:e60325. [PMID: 38883121 PMCID: PMC11177327 DOI: 10.7759/cureus.60325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 06/18/2024] Open
Abstract
INTRODUCTION Benign paroxysmal positional vertigo (BPPV) is the primary vestibular disorder causing peripheral vertigo. Given the role of vitamin D in maintaining otoconia homeostasis, its deficiency may elevate the risk of BPPV. Our study seeks to evaluate the correlation between vitamin D deficiency and clinical outcomes of patients with BPPV in the local Asian population. METHODOLOGY We performed a retrospective analysis of 149 consecutive adult patients referred to a tertiary center's Otolaryngology dizziness clinic between 2018 and 2021. All of these patients had both BPPV and vitamin D deficiency. RESULTS The mean serum vitamin D level was 19.4 ± 5.5 ng/mol. Approximately 51.7% (77/149) of patients experienced recurrent episodes of BPPV. Univariate Chi-square analyses demonstrated vitamin D levels (P < 0.001) and history of migraine (P = 0.04) were related to BPPV recurrence. On multivariate analyses, patients with higher serum vitamin D levels were 16.7% less likely to develop recurrent BPPV (odds ratio [OR] 0.83, 95% confidence interval [CI] 0.76-0.90, P < 0.001). However, migraine history was not significantly related to BPPV recurrence (OR 0.38, 95% CI 0.14-1.00, P = 0.050). There was no statistically significant difference in the duration of BPPV episodes based on vitamin D levels (P = 0.327). CONCLUSIONS Patients with vitamin D deficiency are at higher risk of recurrent BPPV. Future research directions that would be beneficial include conducting a randomized controlled trial to evaluate both the effectiveness of vitamin D supplementation and its optimal dosage.
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Affiliation(s)
- Clarisse Chu
- Otolaryngology, Singapore General Hospital, Singapore, SGP
| | - Yew Meng Chan
- Otolaryngology, Singapore General Hospital, Singapore, SGP
| | - Joyce Tang
- Otolaryngology, Singapore General Hospital, Singapore, SGP
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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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Wood H, Kluk K, BinKhamis G. Association between vitamin D deficiency and benign paroxysmal positional vertigo (BPPV) incidence and recurrence: a systematic review and meta-analysis. BMJ Open 2024; 14:e077986. [PMID: 38653514 PMCID: PMC11043747 DOI: 10.1136/bmjopen-2023-077986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 02/27/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVES The objective of this study is to determine the relationship between serum vitamin D level and the risk of developing benign paroxysmal positional vertigo (BPPV) incidence and recurrence in countries in the Northern Hemisphere. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Scopus and Web of Science databases were searched for studies published between January 2000 and February 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Participants located in the Northern Hemisphere aged 18 or over with at least one episode of BPPV, serum 25-hydroxyvitamin D levels measured and reported, no comorbidities or history of vitamin D supplementation. DATA EXTRACTION AND SYNTHESIS Data extraction and synthesis were performed by a single reviewer and checked by a second reviewer. Inclusion and exclusion criteria and risk of bias were assessed by two independent reviewers using the Newcastle Ottawa Tool for Cohort studies and Risk of Bias Assessment Tool for Nonrandomised Studies checklist for case-control studies. Meta-analysis was conducted using random effects models. Standard mean difference with a 95% CI was used to measure the relationship between vitamin D level and BPPV. RESULTS The 35 articles identified by the literature search reported data of 9843 individuals. 19 studies (7387 individuals) were included in the BPPV incidence meta-analysis while 7 studies (622 individuals) were included in the BPPV recurrence meta-analysis. Lower serum vitamin D levels were found in BPPV incidence compared with controls, but the relationship between vitamin D levels in recurrent BPPV compared with non-recurrent disease remained uncertain. CONCLUSION Results of this systematic review and meta-analysis demonstrated a negative correlation between serum vitamin D and BPPV incidence, while any relationship between serum vitamin D and BPPV recurrence remained uncertain. Risk of bias analysis revealed evidence of variable quality. There were insufficient data available to evaluate seasonal relationships between serum vitamin D and BPPV. Given the potential for this as a confounding factor, future research should aim to investigate this further. PROSPERO REGISTRATION NUMBER CRD42021271840.
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Affiliation(s)
- Heather Wood
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Karolina Kluk
- Manchester Centre for Audiology and Deafness, The University of Manchester, Manchester, UK
| | - Ghada BinKhamis
- Manchester Centre for Audiology and Deafness, The University of Manchester, Manchester, UK
- Cochlear Implant Center, King Fahad Medical City, Riyadh, Saudi Arabia
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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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Miśkiewicz-Orczyk K, Pluskiewicz W, Kos-Kudła B, Misiołek M. Assessment of Osteoporosis and Vitamin D3 Deficiency in Patients with Idiopathic Benign Paroxysmal Positional Vertigo (BPPV). MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050862. [PMID: 37241094 DOI: 10.3390/medicina59050862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023]
Abstract
Background and objectives: Osteoporosis and vitamin D3 deficiency may be risk factors of benign paroxysmal positional vertigo (BPPV). The aim of this study was to assess the prevalence of osteoporosis and 25(OH) vitamin D3 deficiency in a group of patients with idiopathic benign paroxysmal positional vertigo. Materials and Methods: Thirty-five patients (twenty-eight women and seven men) with posterior semicircular canal BPPV were enrolled in the study. The subjects underwent hearing assessment (tonal audiometry and impedance audiometry) and the Dix-Hallpike maneuver. Serum 25(OH) vitamin D3 levels were determined and lumbar spine bone densitometry was performed. The relationships between sex, age, height, Body Mass Index (BMI), vitamin D3 levels and bone densitometry results were assessed. Results: The diagnosis of osteoporosis was confirmed in 1 patient (3%), 3 subjects were osteopenic (8.6%), and normal bone densitometry was found in 31 (88.6%) patients. Conclusions: We found no statistically significant relationships between age, BMI or vitamin D3 levels and bone densitometry results in patients with idiopathic BPPV.
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Affiliation(s)
- Katarzyna Miśkiewicz-Orczyk
- Department of Otorhinolaryngology and Laryngological Oncology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland
| | - Wojciech Pluskiewicz
- Department and Clinic of Internal Diseases, Diabetology, and Nephrology, Metabolic Bone Diseases Unit, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland
| | - Beata Kos-Kudła
- Department of Endocrinology and Neuroendocrine Tumors, Department of Pathophysiology and Endocrinology, Medical University of Silesia, 40-055 Katowice, Poland
| | - Maciej Misiołek
- Department of Otorhinolaryngology and Laryngological Oncology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland
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Evaluation of a questionnaire as a screening tool for benign paroxysmal position vertigo. Eur Arch Otorhinolaryngol 2023; 280:1919-1926. [PMID: 36422670 DOI: 10.1007/s00405-022-07744-6] [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: 09/17/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the value of a questionnaire as a screening tool for benign paroxysmal position vertigo (BPPV). STUDY DESIGN Retrospective chart review. SETTING Tertiary care centers. METHODS A total of 520 vertigo adults completed the questionnaire before the diagnosis was confirmed. After vestibular function examination and other diagnostic examination, the diagnosis of all participants was confirmed by experts. By validating valuable items from the questionnaire with 47 items, a new questionnaire of 5 items was formed to quickly diagnose BPPV. The internal consistency of the new questionnaire and validity were evaluated. The correlation between the score obtained from the new questionnaire and diagnosis was investigated. The mean score was also compared between groups with and without BPPV and diagnostic precision measures were calculated. RESULTS 520 vertigo participants answered all the question completely and BPPV was identified in 138 participants (26.5%). The responses to questionnaire revealed preferable reproducibility (r = 0.898, P < 0.05) and internal consistency (Cronbach's α = 0.702) as well as the validity (Kaiser-Meyer-Olkin, KMO = 0.731). The higher the individual score, the more likely to be BPPV (B = 2.082; P < 0.05). The mean score of answers was greater in the group with a clinical diagnosis of BPPV compared to those without BPPV (F = 58.459, P < 0.05). The sensitivity of the screening tool was 92.8% and specificity was 88.5%, with an area under the ROC curve of 0.946 (95% confidence interval 0.926-0.965; P < 0.05). CONCLUSION The questionnaire proved to be of great value to screen for individuals with possible BPPV.
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Moen CM, Kontorinis G. Analysis of patient variables including socioeconomic indicators and their association with recurrence rates and persistence of benign paroxysmal positional vertigo: A retrospective case series. Clin Otolaryngol 2023. [PMID: 36938827 DOI: 10.1111/coa.14050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/13/2023] [Accepted: 03/05/2023] [Indexed: 03/21/2023]
Affiliation(s)
- Christy M Moen
- Department of Otolaryngology, Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Georgios Kontorinis
- Department of Otolaryngology, Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow, UK.,Glasgow University Medical School, University of Glasgow, Glasgow, UK
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Nakata T, Okada M, Nishihara E, Ikedo A, Asoh S, Takagi T, Tokunaga N, Hato N, Imai Y. Effect of hormonal therapy on the otoconial changes caused by estrogen deficiency. Sci Rep 2022; 12:22596. [PMID: 36585504 PMCID: PMC9803649 DOI: 10.1038/s41598-022-27240-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) is associated with menopause and/or osteopenia. Morphological changes in the otoconial layer have been reported after ovariectomy (OVX). Moreover, hormone replacement therapy decreases BPPV risk. However, knowledge concerning the effect of hormonal therapy on the otoconial changes caused by estrogen deficiency is limited. We aimed to examine the effect of hormonal therapy on otoconial changes caused by estrogen deficiency. We hypothesized that hormonal therapy could reduce otoconial changes caused by OVX. Eight-week-old C57BL/6 mice were divided into four groups: sham operation with implantation of vehicle (sham + v), OVX with implantation of vehicle (OVX + v), OVX with implantation of estradiol (E2) (OVX + E2), and OVX with implantation of raloxifene (RAL) (OVX + RAL) groups. Otoconial layer volume was measured by micro-CT at 4 weeks after OVX or the sham operation. The otic bullae were removed; immunohistochemistry was performed for estrogen receptor alpha and 4-hydroxynonenal. Otoconial layer volume was significantly higher in the OVX + v than in the sham + v group. E2 and RAL significantly reduced these changes in the endometrial layer. The staining of estrogen receptor alpha and 4-hydroxynonenal were stronger in the OVX + v than in the sham + v group but equal in the sham + v, OVX + E2, and OVX + RAL groups. These results indicate that E2 and RAL are effective against morphological changes of the otoconial layer caused by estrogen deficiency via oxidative stress reduction.
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Affiliation(s)
- Takahiro Nakata
- grid.255464.40000 0001 1011 3808Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295 Japan ,Department of Otolaryngology, Ehime Prefectural Niihama Hospital, Niihama, Japan
| | - Masahiro Okada
- grid.255464.40000 0001 1011 3808Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295 Japan
| | - Eriko Nishihara
- grid.255464.40000 0001 1011 3808Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295 Japan
| | - Aoi Ikedo
- grid.255464.40000 0001 1011 3808Division of Integrative Pathophysiology, Proteo-Science Center, Ehime University, Toon, Japan
| | - Sawa Asoh
- grid.255464.40000 0001 1011 3808Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295 Japan
| | - Taro Takagi
- grid.255464.40000 0001 1011 3808Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295 Japan
| | - Naohito Tokunaga
- grid.255464.40000 0001 1011 3808Division of Medical Research Support the Advanced Research Support Center, Ehime University, Toon, Japan
| | - Naohito Hato
- grid.255464.40000 0001 1011 3808Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295 Japan
| | - Yuuki Imai
- grid.255464.40000 0001 1011 3808Division of Integrative Pathophysiology, Proteo-Science Center, Ehime University, Toon, Japan ,grid.255464.40000 0001 1011 3808Department of Pathophysiology, Ehime University Graduate School of Medicine, Toon, Japan ,grid.255464.40000 0001 1011 3808Division of Laboratory Animal Research, Advanced Research Support Center, Ehime University, Toon, Japan
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García A, Rivera S, Alvear-Veas B, Goss D, Castillo-Bustamante M, Garcia JM. Association Between Early-Onset Osteoporosis With Hearing Loss and Benign Paroxysmal Positional Vertigo (BPPV): A Systematic Review and Meta-Analysis. Ann Otol Rhinol Laryngol 2022:34894221118424. [PMID: 35950312 DOI: 10.1177/00034894221118424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Osteoporosis is a chronic systemic disease characterized by low bone mass, progressive microarchitectural deterioration and increased bone fragility. Hearing loss and benign paroxysmal positional vertigo (BPPV) have been found in patients diagnosed with osteoporosis over 65 years, however, there is lack of information about these conditions in young patients. Herein, we conducted a systematic review and meta-analysis to provide evidence of the association between osteoporosis and audio-vestibular findings in young subjects. METHODS Systematic review and meta-analysis were performed according to PRISMA guidelines. Searches were conducted in PubMed, Embase, and Web of Science Core Collection. Mean age, proportion of patients with low mineral density, hearing loss, and BPPV were calculated for the systematic review and meta-analysis. Odds Ratio (OR) with their corresponding 95% confidence intervals (CI) were calculated. RESULTS A total of 26 articles were reviewed. Only 10 studies met inclusion criteria for the meta-analysis. Six were assessed pursuing the association between osteoporosis and hearing loss. Pooled evidence suggested in patients with osteoporosis, an increased risk for developing hearing loss (OR = 1.52, 95% CI 1.06-2.19; P = .02) compared to controls. Another 6 studies reported the association between osteoporosis and BPPV. A significant increased risk for BPPV was found in individuals with osteoporosis (OR = 1.58, 95% CI 1.02-2.4; P = .04). There was no publication bias. CONCLUSION Subjects younger than 65 years with osteoporosis have an increase odds for hearing loss and BPPV compared to controls. These conditions could be associated with early inner or middle ear bone morphologic changes.
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Affiliation(s)
- Alejandro García
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston, MA, USA
| | - Sebastián Rivera
- Escuela de Fonoaudiología, Facultad de Salud, Universidad Santo Tomas, Viña del Mar, Chile
| | - Bernardita Alvear-Veas
- Departamento de Fonoaudiología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Deborah Goss
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston, MA, USA
| | - Melissa Castillo-Bustamante
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston, MA, USA.,Escuela de Medicina, Escuela de Ciencias de la Salud, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Juan Manuel Garcia
- Departamento de Otorrinolaringologia, Fundación Santa Fé de Bogotá, Universidad de Los Andes, Bogota, Colombia
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Predictive values of serum estradiol, calcium, and 25-hydroxyvitamin D levels for recurrence of benign paroxysmal positional vertigo in postmenopausal women. Turk J Phys Med Rehabil 2022; 68:30-36. [PMID: 35949966 PMCID: PMC9305638 DOI: 10.5606/tftrd.2022.5964] [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: 01/22/2020] [Accepted: 06/17/2020] [Indexed: 12/03/2022] Open
Abstract
Objectives
This study aims to explore the predictive values of serum estradiol, calcium and 25-hydroxyvitamin D [25(OH)D] levels for benign paroxysmal positional vertigo (BPPV) recurrence in postmenopausal women.
Patients and methods
A total of 156 postmenopausal women (mean age: 59.5±7.4 years; range, 46 to 75 years) diagnosed with primary BPPV between January 2015 and August 2018 were included. After follow-up for one year, they were divided into non-recurrence (n=126) and recurrence groups (n=30). Fifty healthy females (mean age: 60.3±7.4 years; range, 48 to 75 years) with natural menopause for over one year were enrolled as the control group. Serum estradiol, calcium and 25(OH)D levels were compared, and their correlations in the recurrence group were analyzed by Pearson method. The predictive values of these levels for recurrence were evaluated using the receiver operating characteristic curve. Predisposing factors were determined by univariate and multivariate logistic regression analyses.
Results
Serum estradiol, calcium, and 25(OH)D levels of the control group were significantly higher than the non-recurrence and recurrence groups (p<0.05). The levels of recurrence group exceeded those of non-recurrence group (p<0.05). In recurrence group, estradiol level was positively correlated with those of calcium and 25(OH)D (r=0.7501, 0.7871, p<0.001), and calcium level was positively correlated with that of 25(OH)D (r=0.7904, p<0.001). The three levels had diagnostic values for recurrence. The maximum Youden’s index of their combination was 0.476, and the corresponding prognostic index was 13.04, suggesting a higher recurrence probability. Number of repositioning, Self-Rating Depression Scale score, levels of estradiol, calcium and 25(OH)D were predisposing factors for recurrence.
Conclusion
Serum estradiol, calcium, and 25(OH)D levels are significantly positively correlated in postmenopausal women with BPPV recurrence and their combination can be used to predict recurrence.
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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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12
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Risk Factors for Recurrence of Benign Paroxysmal Positional Vertigo. A Clinical Review. J Clin Med 2021; 10:jcm10194372. [PMID: 34640391 PMCID: PMC8509726 DOI: 10.3390/jcm10194372] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/17/2021] [Accepted: 09/23/2021] [Indexed: 12/04/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular dysfunctions encountered in clinical practice. Although the treatment of BPPV is relatively successful, many patients develop recurrence after treatment. Our purpose is to evaluate the mean recurrence rate and risk factors of BPPV after treatment. A review of the literature on the risk factors of BPPV recurrence was performed. A thorough search was conducted using electronic databases, namely Pubmed, CINAHL, Academic Search Complete and Scopus for studies published from 2000 to 2020. Thirty studies were included in this review with 13,358 participants. The recurrence rate of BPPV ranged from 13.7% to 48% for studies with follow-up <1 year, and from 13.3% to 65% for studies with follow-up ≥2 years. Pathophysiologic mechanisms and implication of each of the following risk factors in the recurrence of BPPV were described: advanced age, female gender, Meniere’s disease, trauma, osteopenia or osteoporosis, vitamin D deficiency, diabetes mellitus, hypertension, hyperlipidemia, cardiovascular disease, migraine, bilateral/multicanal BPPV, cervical osteoarthrosis and sleep disorders. Patients with hyperlipidemia and hypertension had the highest recurrence rates of BPPV, 67.80% and 55.89%, respectively, indicating that vascular comorbidities increase the risk of BPPV recurrence. In addition, more than half of patients (53.48%) with diabetes mellitus and BPPV experienced recurrence of BPPV. Knowledge and awareness of risk factors for recurrence of BPPV are essential for the assessment and long-term prognosis of patients. Identification of these relapse risk factors may enhance the ability of clinicians to accurately counsel patients regarding BPPV and associated comorbidities.
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Pollak L, Gilad R, Michael T. Unilateral mimicking bilateral BPPV- a forgotten entity? Characteristics of a large cohort of patients, comparison with posterior canal BPPV and clinical implications. J Otol 2021; 16:252-257. [PMID: 34548872 PMCID: PMC8438632 DOI: 10.1016/j.joto.2021.06.002] [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: 04/15/2021] [Revised: 05/16/2021] [Accepted: 06/16/2021] [Indexed: 12/02/2022] Open
Abstract
Objective Unilateral mimicking bilateral benign paroxysmal positional vertigo (umb-BPPV) was attributed to inappropriate head positioning during testing of the posterior canal. Despite its inclusion in the Diagnostic criteria for the classification of vestibular disorders of the Bárány Society, the clinical characteristics and treatment responsiveness of this BPPV subtype have not been intensively studied. Methods Records of patients with BPPV seen at a single outpatient dizziness clinic during the years 2000–2020 were reviewed. Eighty seven patients with umb-BPPV and 86 random patients with posterior canal BPPV (p-BPPV) were retrieved. Their demographics and BPPV characteristics were analyzed. Results Patients' and BPPV characteristics were similar in umb- and p-BPPV except for the prevalence of males in the umb-BPPV group. No differences were found between treatment responsiveness and recurrences in both groups. The recurrence rate of umb-BPPV was not influenced by age, gender, BPPV side, duration of symptoms or treatment responsiveness during the first attack. Conclusions In accordance with our hypothesis about mixed canalo- and cupulolithiasis as the underlying mechanism of umb-BPPV, patients did not differ in characteristics and treatment responsiveness from p-BPPV patients. Recognition of umb-BPPV is important since inappropriate treatment can cause an unnecessary delay in therapy success.
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Affiliation(s)
- Lea Pollak
- Neurology and Dizziness Clinic, Kupat Cholim Macabi and the Ben Gurion, University of the Negev, Beer Sheva, Israel
| | - Ronit Gilad
- Neurology Department, Kaplan Medical Center, Rechovot, Affiliated to the Hebrew, University, Jerusalem, Israel
| | - Tal Michael
- The Faculty of Health Public, Ben Gurion University of the Negev, Beer, Sheva, Israel
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14
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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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15
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Serum otolin-1 as a biomarker for benign paroxysmal positional vertigo: a case-control study. J Laryngol Otol 2021; 135:589-592. [PMID: 34137365 DOI: 10.1017/s0022215121001274] [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] [Indexed: 11/07/2022]
Abstract
OBJECTIVES This study aimed to evaluate serum otolin-1 levels in patients with benign paroxysmal positional vertigo and to compare these levels with healthy individuals. METHOD This was a case-control study. After obtaining institutional ethical committee clearance, the serum level of otolin-1 was calculated in adult individuals (18-75 years old) who were divided into group 1 (patients presenting with benign paroxysmal positional vertigo) and group 2 (healthy patients without benign paroxysmal positional vertigo as the control group). Data analysis was carried out to compare the serum levels in the cases and controls. A p-value less than 0.05 was considered significant. RESULTS A total of 70 age-matched individuals (cases, n = 40; controls, n = 30) were included in the study. The mean serum level of otolin-1 was 636.8 pg/ml (range, 259-981 pg/ml) in the group of patients with benign paroxysmal positional vertigo and 236.2 pg/ml (range, 189-370 pg/ml) in the control group. The difference was statistically significant (p = 0.0000). CONCLUSION The serum levels of otolin-1 in patients with benign paroxysmal positional vertigo are significantly higher compared with individuals without benign paroxysmal positional vertigo.
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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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17
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Abstract
PURPOSE OF REVIEW In the last three decades, the use of eye movements and vestibular testing in many neurological disorders has accelerated, primarily because of practical technologic developments. Although the acute vestibular syndrome is a prime example of this progress, more chronic neurologic and systemic disorders have received less attention. We focus here on recent contributions relating vestibular and ocular motor abnormalities in inflammatory, demyelinating, metabolic, and peripheral nervous system disorders RECENT FINDINGS: Vestibular abnormalities have been identified in acute demyelinating neuropathies (AIDP), in novel genetic mutations responsible for CANVAS (cerebellar ataxia, neuropathy vestibular areflexia syndrome), and in other inherited neuropathies (variants of Charcot-Marie-Tooth disease). In addition, there are differentiating characteristics between the most common CNS demyelinating disorders: multiple sclerosis and neuromyelitis optica (NMO). We summarize new information on Vitamin D metabolism in benign paroxysmal positional vertigo (BPPV), followed by a brief review of the vestibular and ocular motor findings in Wernicke's encephalopathy. We conclude with findings in several paraneoplastic/autoimmune disorders. SUMMARY This literature review highlights the impact of a careful vestibular and ocular motor evaluation in common neurologic disorder, not only for the initial diagnosis but also for monitoring disease and rehabilitation. A careful examination of eye movements and vestibular function, supplemented with new video techniques to quantify the findings, should be part of the standard neurologic examination.
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18
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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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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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20
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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: 22] [Impact Index Per Article: 5.5] [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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21
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Jeong SH, Lee SU, Kim JS. Prevention of recurrent benign paroxysmal positional vertigo with vitamin D supplementation: a meta-analysis. J Neurol 2020; 269:619-626. [DOI: 10.1007/s00415-020-09952-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/24/2020] [Accepted: 05/26/2020] [Indexed: 10/23/2022]
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22
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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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23
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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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24
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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: 7] [Impact Index Per Article: 1.8] [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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25
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Nishihara E, Okada M, Kiyoi T, Shudou M, Imai Y, Hato N. Evaluation of the structure of the otoconial layer using micro-computed tomography. Auris Nasus Larynx 2020; 47:734-739. [PMID: 32173170 DOI: 10.1016/j.anl.2020.02.013] [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: 11/26/2019] [Revised: 01/20/2020] [Accepted: 02/26/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Estrogen deficiency caused by bilateral ovariectomy (OVX) has been reported to lead to morphological changes in otoconia. Thus, we examined the morphological changes in the otoconial layer after OVX. We also investigated whether micro-computed tomography (µCT) is useful for the detection of morphological changes in the otoconial layer. METHODS The otic capsules of C57BL/6 J mice were removed and evaluated using histological techniques and µCT at 2, 4, and 8 weeks after OVX or sham surgery. The volume of the utricle otoconial layer was measured and compared between the OVX and sham groups. The µCT scan and histological study results were also compared. RESULTS The volume of the utricle otoconial layer was significantly increased 4 weeks after OVX compared to the sham group in both histological and µCT studies (p < 0.05). The volume of the otoconial layer measured using µCT was significantly correlated with the histological study results (p < 0.05). CONCLUSION The volume of the utricle otoconial layer increased after OVX. These morphological changes could be detected by µCT.
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Affiliation(s)
- Eriko Nishihara
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Masahiro Okada
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Ehime, Japan.
| | - Takeshi Kiyoi
- Division of Analytical Bio-medicine, Advanced Research Support Center, Ehime University, Ehime, Japan
| | - Masachika Shudou
- Division of Analytical Bio-medicine, Advanced Research Support Center, Ehime University, Ehime, Japan
| | - Yuuki Imai
- Division of Integrative Pathophysiology, Proteo-Science Center, Ehime University, Ehime, Japan; Department of Pathophysiology, Ehime University Graduate School of Medicine, Ehime, Japan; Division of Laboratory Animal Research, Advanced Research Support Center, Ehime University, Ehime, Japan
| | - Naohito Hato
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
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26
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Han K, Yun YM, Moon SG, Kim CH. Bone mineral density and serum 25-hydroxyvitamin D in subtypes of idiopathic benign paroxysmal positional vertigo. Am J Otolaryngol 2020; 41:102313. [PMID: 31732302 DOI: 10.1016/j.amjoto.2019.102313] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 10/01/2019] [Indexed: 11/28/2022]
Abstract
Although the etiology of benign paroxysmal positional vertigo (BPPV) is idiopathic in most cases, the association of osteoporosis or vitamin D deficiency with BPPV has attracted much interest recently. While it is generally accepted that osteoporosis or vitamin D deficiency is related to the occurrence and/or recurrence of BPPV, the difference in serum vitamin D level and bone mineral density (BMD) among different subtypes of BPPV has not been investigated. We aimed to compare T-score of BMD score and serum 25-hydroxyvitamin D level among idiopathic BPPV patients with a different subtype. This study included 117 consecutive patients with idiopathic BPPV (26 men and 91 women; mean age, 55 ± 11 years; age range, 25 to 78 years) who underwent blood sampling for serum 25-hydroxyvitamin D level measurement and bone mineral densitometry of the anterior-posterior lumbar spine and femur between April 2018 and February 2019. Among 117 patients, 49 were diagnosed with posterior semicircular canal (PSCC) BPPV, 24 were diagnosed with lateral semicircular canal (LSCC) canalolithiasis, and 44 were diagnosed with LSCC cupulolithiasis. The mean T-score of BMD was -1.5 ± 0.9 in PSCC BPPV, -1.5 ± 1.3 in LSCC canalolithiasis, and -1.5 ± 1.1 in LSCC cupulolithiasis, which was not significantly different (p = 0.998, One-way ANOVA test). The mean level of 25-hydroxyvitamin D was 22.5 ± 10.6 ng/ml in PSCC BPPV, 26.8 ± 16.0 ng/ml in LSCC canalolithiasis, and 25.4 ± 9.6 ng/ml in LSCC cupulolithiasis, which was not significantly different (p = 0.262, One-way ANOVA test). The proportion of osteoporosis/osteopenia or vitamin D deficiency/insufficiency did not show significant difference among idiopathic BPPV patients with different subtypes, and findings of this study indicate that either serum level of vitamin D or T-score of BMD is not a distinguishable characteristic among different subtypes of BPPV.
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Affiliation(s)
- Kyujin Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Yeo-Min Yun
- Department of Laboratory Medicine, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sung Gyu Moon
- Department of Radiology, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Chang-Hee Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea.
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27
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Abstract
The pathophysiological mechanism underlying benign paroxysmal positional vertigo (BPPV) is related to free-floating debris/otoliths in the semicircular canal (canalolithiasis) or debris/otoliths attached to the cupula (cupulolithiasis). These debris/otoliths are considered to originally accumulate after detachment from the neuroepithelium of the utricular macula secondary to a type of degeneration. An idiopathic form, which is assumed to occur spontaneously, is diagnosed when the causative pathology is obscure. However, an association between various other systemic or inner ear conditions and BPPV has been reported, indicating the existence of secondary BPPV. This study was performed to present the first review of the pathology underlying BPPV following a complete PubMed/Medline search. In total, 1932 articles published from 1975 to 2018 were reviewed. The articles were classified according to 17 potentially causative factors (aging; migraine; Meniere's disease; infection; trauma; idiopathic sudden sensorineural hearing loss; sleeping habits; osteoporosis and vitamin D insufficiency; hyperglycemia and diabetes mellitus; chronic head and neck pain; vestibule or semicircular canal pathology; pigmentation disorders; estrogen deficiency; neurological disorders; autoimmune, inflammatory, or rheumatologic disorders; familial or genetic predisposition; and allergy). A discussion of the underlying cause of BPPV for each factor is presented.
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Affiliation(s)
- Sertac Yetiser
- Department of Otolaryngology-Head and Neck Surgery, Anadolu Medical Center, Gebze, Kocaeli, Turkey
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28
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Bazoni JA, Ciquinato DSA, Marquez ADS, Costa VDSP, Marchiori GDM, Marchiori LLDM. Hypovitaminosis D, Low Bone Mineral Density, and Diabetes Mellitus as Probable Risk Factors for Benign Paroxysmal Positional Vertigo in the Elderly. Int Arch Otorhinolaryngol 2019; 24:e272-e277. [PMID: 32754236 PMCID: PMC7394622 DOI: 10.1055/s-0039-1700583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 09/12/2019] [Indexed: 11/08/2022] Open
Abstract
Introduction
Studies have found that elderly patients with benign paroxysmal positional vertigo (BPPV) may present low levels of vitamin D (25 (OH) D), changes in bone mineral density, and diabetes mellitus (DM).
Objective
: To investigate the possible association between BPPV, bone mineral density, hypovitaminosis D, 25 (OH) D and DM.
Methods
The sample consisted of 109 elderly subjects. The BPPV was verified by a standardized questionnaire and the Dix-Hallpike maneuver. Blood samples were collected for the investigation of 25 (OH) D serum levels. The bone mineral density was evaluated by means of a densitometer. Diabetes mellitus verification was performed using a self-reported questionnaire.
Results
Of the 109 participants, 17 had BPPV. There was a statistically significant difference between BPPV and gender (
p
= 0.027, phi = 0.222), with female representing 88.2% of those with BPPV. In the group with BPPV, there was a statistically significant difference for the amount of vitamin D found (
p
= 0.001) and for age (
p
= 0.001). In the elderly group with DM and BPPV, a difference was found for the standard deviation of the femur (
p
= 0.022) with posthoc Dunn, identifying the difference between diabetics with and without BPPV (
p
= 0.047).
Conclusion
Although no association was found (25 (OH) D levels) with BPPV in the general population of this study, it was observed that there was an association with bone mineral density in the elderly group with DM and BPPV, and, in the group with BPPV, there was an association between the amount of vitamin D and age.
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29
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Yang B, Lu Y, Xing D, Zhong W, Tang Q, Liu J, Yang X. Association between serum vitamin D levels and benign paroxysmal positional vertigo: a systematic review and meta-analysis of observational studies. Eur Arch Otorhinolaryngol 2019; 277:169-177. [PMID: 31630244 DOI: 10.1007/s00405-019-05694-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/08/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Benign paroxysmal positional vertigo (BPPV) was the most common neuro-otological disorder manifests as recurrent positional vertigo, but its risk factors are elusive. Recent studies suggest that decreased Vitamin D level may be a risk factor, but the literature is inconsistent. METHODS The databases PubMed, Web of Science, Chinese National Knowledge Infrastructure, Wanfang, SinoMed, and Embase were systematically searched for studies on the association between BPPV and serum Vitamin D levels published up to June 2019. Data from eligible studies were meta-analyzed using Stata 12.0. RESULTS A total of 18 studies were included in the analysis. Serum Vitamin D levels were significantly lower in individuals with BPPV than in controls (WMD - 2.46, 95% CI - 3.79 to - 1.12, p < 0.001). Subgroup analysis by geographical area showed that vitamin D level was significantly lower in BPPV than in controls in China (WMD - 3.27, 95% CI - 4.12 to - 2.43, p < 0.001), but not outside China (WMD - 0.90, 95% CI - 4.36 to 2.56, p = 0.611). Vitamin D levels were significantly lower in recurrent than non-recurrent BPPV across all countries in the sample (WMD 2.59, 95% CI 0.35-4.82, p = 0.023). Vitamin D deficiency emerged as an independent risk factor of BPPV (OR 1.998, 95% CI 1.400-2.851, p < 0.001). CONCLUSION The available evidence suggests that BPPV is associated with decreased levels of serum Vitamin D, and vitamin D deficiency was an independent risk factor for BPPV.
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Affiliation(s)
- Baiyuan Yang
- Department of Neurology, Seventh People's Hospital of Chengdu, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yongxia Lu
- Department of Endocrinology, Seventh People's Hospital of Chengdu, Chengdu, 610041, Sichuan, People's Republic of China
| | - Dongmei Xing
- Department of Neurology, The Third People's Hospital of Yunnan Province, Kunming, 650011, Yunnan, People's Republic of China
| | - Wei Zhong
- Department of Neurology, Seventh People's Hospital of Chengdu, Chengdu, 610041, Sichuan, People's Republic of China
| | - Qing Tang
- Department of Neurology, Seventh People's Hospital of Chengdu, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jingyu Liu
- Department of Endocrinology, Seventh People's Hospital of Chengdu, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xinglong Yang
- Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, People's Republic of China.
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30
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Serum levels of 25-hydroxy vitamin D correlate with idiopathic benign paroxysmal positional vertigo. Biosci Rep 2019; 39:BSR20190142. [PMID: 30962270 PMCID: PMC6488856 DOI: 10.1042/bsr20190142] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/19/2019] [Accepted: 03/27/2019] [Indexed: 02/05/2023] Open
Abstract
Background: The present study aimed to evaluate serum 25-hydroxy vitamin D (25(OH) D) levels in Chinese patients with idiopathic benign paroxysmal positional vertigo (BPPV) and to investigate the possible relationship between the occurrence and recurrence of idiopathic BPPV and low 25(OH) D levels. Methods: Between 1 January 2017 and 31 May, 2018, consecutively older patients (age, older than 50 years) with idiopathic BPPV were recruited in the present study. For each patient, 2:1 sex and age matched healthy people were assigned as the control group. The influence of 25(OH) D levels on BPPV and recurrent BPPV were performed by binary logistic regression analysis. Results: In the present study, 174 patients with BPPV and 348 controls were included. The serum levels of 25(OH) D in those patients were lower than in those controls (P<0.001). One hundred eight patients were found to have vitamin D deficiency; thus, the prevalence was 62.1%, which was higher than that in the controls (42.8%). The data showed that patients with recurrent BPPV (N = 31) had lower serum levels of 25(OH) D compared with those who were not (11.2 ng/ml [interquartile range, 7.2–20.8 ng/ml] vs 18.7 ng/ml [14.2–24.8 ng/ml]). The regression analyses demonstrated that vitamin D deficiency was associated with BPPV and recurrent BPPV with an odds ratio of 2.15 (95% confidence interval [CI], 1.30–4.32; P=0.006) and 5.16 (95% CI, 1.00–34.12; P=0.05). Conclusion: Decreased serum levels of 25(OH)D were associated with the occurrence and recurrence of BPPV in a Chinese population, independent of other baseline markers.
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31
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Carneiro de Sousa PJM, Abreu Pereira DM, Carneiro Melo Pereira de Magalhães P, Duarte DRDS, Trigueiros da Silva Cunha NM. Vitamin D deficiency and benign paroxysmal positioning vertigo. HEARING BALANCE AND COMMUNICATION 2019. [DOI: 10.1080/21695717.2019.1590988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Diogo Manuel Abreu Pereira
- Otorhinolaryngology Department, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Porto, Portugal
| | | | - Delfim Rui da Silva Duarte
- Otorhinolaryngology Department, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Porto, Portugal
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32
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Association between bone mineral density and benign paroxysmal positional vertigo: a meta-analysis. Eur Arch Otorhinolaryngol 2019; 276:1561-1571. [DOI: 10.1007/s00405-019-05345-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/12/2019] [Indexed: 12/22/2022]
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33
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Rabbitt RD. Semicircular canal biomechanics in health and disease. J Neurophysiol 2019; 121:732-755. [PMID: 30565972 PMCID: PMC6520623 DOI: 10.1152/jn.00708.2018] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/11/2018] [Accepted: 12/11/2018] [Indexed: 12/12/2022] Open
Abstract
The semicircular canals are responsible for sensing angular head motion in three-dimensional space and for providing neural inputs to the central nervous system (CNS) essential for agile mobility, stable vision, and autonomic control of the cardiovascular and other gravity-sensitive systems. Sensation relies on fluid mechanics within the labyrinth to selectively convert angular head acceleration into sensory hair bundle displacements in each of three inner ear sensory organs. Canal afferent neurons encode the direction and time course of head movements over a broad range of movement frequencies and amplitudes. Disorders altering canal mechanics result in pathological inputs to the CNS, often leading to debilitating symptoms. Vestibular disorders and conditions with mechanical substrates include benign paroxysmal positional nystagmus, direction-changing positional nystagmus, alcohol positional nystagmus, caloric nystagmus, Tullio phenomena, and others. Here, the mechanics of angular motion transduction and how it contributes to neural encoding by the semicircular canals is reviewed in both health and disease.
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Affiliation(s)
- R. D. Rabbitt
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah
- Otolaryngology-Head Neck Surgery, University of Utah, Salt Lake City, Utah
- Neuroscience Program, University of Utah, Salt Lake City, Utah
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34
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Balatsouras DG, Koukoutsis G, Fassolis A, Moukos A, Apris A. Benign paroxysmal positional vertigo in the elderly: current insights. Clin Interv Aging 2018; 13:2251-2266. [PMID: 30464434 PMCID: PMC6223343 DOI: 10.2147/cia.s144134] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Balance disorders, unsteadiness, dizziness and vertigo in the elderly are a significant health problem, needing appropriate treatment. One third of elderly patients with vertigo were diagnosed with benign paroxysmal positional vertigo (BPPV), the most common cause of dizziness in both primary care specialist Neurology and Ear Nose Throat settings. BPPV presents a specific paroxysmal positional nystagmus which can be obtained using the appropriate diagnostic positional test and can be treated effectively using specific therapeutic maneuvers. This review presents current insights into the diagnostic, pathogenetic and therapeutic aspects of BPPV in the elderly. BPPV in older patients does not differ significantly from BPPV in younger patients, with regard to pathogenesis, diagnosis and treatment. However, in older patients, its prevalence is higher and it responds less effectively to treatment, having a tendency for recurrence. Specific issues which should be considered in the elderly are: 1) difficulty in obtaining an accurate history; 2) difficulty in performing the diagnostic and therapeutic maneuvers, which should be executed with slow and gentle movements and extremely cautiously to avoid any vascular or orthopedic complications; and 3) the relation between BPPV and falls.
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Affiliation(s)
- D G Balatsouras
- Department of ENT, Tzanion General Hospital of Piraeus, Piraeus, Greece,
| | - G Koukoutsis
- Department of ENT, Tzanion General Hospital of Piraeus, Piraeus, Greece,
| | - A Fassolis
- Department of ENT, Tzanion General Hospital of Piraeus, Piraeus, Greece,
| | - A Moukos
- Department of ENT, Tzanion General Hospital of Piraeus, Piraeus, Greece,
| | - A Apris
- Department of ENT, Nicosia General Hospital, Nicosia, Cyprus
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35
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Wu Y, Fan Z, Jin H, Guan Q, Zhou M, Lu X, Li L, Yan W, Gu C, Chen C, Han W. Assessment of Bone Metabolism in Male Patients With Benign Paroxysmal Positional Vertigo. Front Neurol 2018; 9:742. [PMID: 30233488 PMCID: PMC6135048 DOI: 10.3389/fneur.2018.00742] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 08/16/2018] [Indexed: 11/13/2022] Open
Abstract
Objective: Several studies have suggested a probable association between benign paroxysmal positional vertigo (BPPV) and both reduction of bone mineral density (BMD) and serum vitamin D levels, but none of these studies have explored their findings by examining bone turnover markers (BTM) in male idiopathic BPPV patients. This study aimed to evaluate the relationship between BMD and serum 25-hydroxyvitamin D (25(OH) D), with the occurrence of BPPV along with the characteristics of bone metabolism in male idiopathic BPPV patients. Methods: This retrospective study comprised 60 male idiopathic BPPV patients and 92 age-matched healthy controls referred to Ningbo No.2 Hospital during the period of February 2016 to February 2018. All subjects' serum levels of 25(OH) D, bone formation marker amino-terminal propeptide of type I procollagen (PINP), and bone resorption marker β-isomerized carboxy-terminal telopeptide of type I collagen (β-CTX) were measured. BMD was determined by dual energy X-ray absorption at the lumbar spine and hip. Results: Among male patients with BPPV, the prevalence of BMD reduction was 35.0%, which was similar to that of 27.2% in healthy controls. There were significant differences in the mean serum 25(OH) D level and prevalence of vitamin D deficiency between the two groups, with p-values of 0.049 and 0.009, respectively. The bone turnover markers of PINP and β-CTX in BPPV patients were lower than those in healthy controls. Logistic regression showed that vitamin D deficiency were associated with BPPV with an odds ratio of 3.8 (95% confidence interval = 1.25-11.73). Conclusion: Our study found that decreased serum vitamin D may be a risk factor for BPPV in male patients. The level of bone turnover among male patients with BPPV was lower than that among healthy controls.
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Affiliation(s)
- Yunqin Wu
- Department of Neurology, Ningbo No. 2 Hospital, Ningbo, China
| | - Zhenyi Fan
- Department of Neurology, Ningbo No. 2 Hospital, Ningbo, China
| | - Hang Jin
- Department of Neurology, First Hospital of Jilin University, Changchun, China
| | - Qiongfeng Guan
- Department of Neurology, Ningbo No. 2 Hospital, Ningbo, China
| | - Min Zhou
- Department of Neurology, Ningbo No. 2 Hospital, Ningbo, China
| | - Xiaoxiong Lu
- Department of Neurology, Ningbo No. 2 Hospital, Ningbo, China
| | - Li Li
- Department of Neurology, Ningbo No. 2 Hospital, Ningbo, China
| | - Wang Yan
- Department of Neurology, Ningbo No. 2 Hospital, Ningbo, China
| | - Chengyao Gu
- Department of Neurology, Ningbo No. 2 Hospital, Ningbo, China
| | - Caijing Chen
- Department of Neurology, Ningbo No. 2 Hospital, Ningbo, China
| | - Weiwei Han
- Department of Neurology, Ningbo No. 2 Hospital, Ningbo, China.,Department of Rehabilitation, Ningbo No. 2 Hospital, Ningbo, China
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