Therapeutic Effect of the Correction of Vitamin D Deficiency in Patients with Benign Paroxysmal Positional Vertigo. A Randomized Clinical Trial

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.

Keywords

benign paroxysmal positional vertigo - deficiency - vitamin D

Publication History

Received: 15 July 2020

Accepted: 14 February 2021

Article published online:
13 April 2022

• References

• 1 Silva C, Amorim AM, Paiva A. Benign paroxysmal positional vertigo--a review of 101 cases. Acta Otorrinolaringol Esp 2015; 66 (04) 205-209 DOI: 10.1016/j.otorri.2014.09.003.
• 2 Davies RA, Luxon LM. Dizziness following head injury: a neuro-otological study. J Neurol 1995; 242 (04) 222-230 DOI: 10.1007/BF00919595.
• 3 Talaat HS, Abuhadied G, Talaat AS, Abdelaal MS. Low bone mineral density and vitamin D deficiency in patients with benign positional paroxysmal vertigo. Eur Arch Otorhinolaryngol 2015; 272 (09) 2249-2253 DOI: 10.1007/s00405-014-3175-3.
• 4 Nunez RA, Cass SP, Furman JM. Short- and long-term outcomes of canalith repositioning for benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 2000; 122 (05) 647-652 DOI: 10.1016/S0194-5998(00)70190-2.
• 5 Sakaida M, Takeuchi K, Ishinaga H, Adachi M, Majima Y. Long-term outcome of benign paroxysmal positional vertigo. Neurology 2003; 60 (09) 1532-1534 DOI: 10.1212/01.wnl.0000061477.03862.4d.
• 6 Brandt T, Huppert D, Hecht J, Karch C, Strupp M. Benign paroxysmal positioning vertigo: a long-term follow-up (6-17 years) of 125 patients. Acta Otolaryngol 2006; 126 (02) 160-163 DOI: 10.1080/00016480500280140.
• 7 Talaat HS, Kabel AM, Khaliel LH, Abuhadied G, El-Naga HA, Talaat AS. Reduction of recurrence rate of benign paroxysmal positional vertigo by treatment of severe vitamin D deficiency. Auris Nasus Larynx 2016; 43 (03) 237-241 DOI: 10.1016/j.anl.2015.08.009.
• 8 Jeong SH, Kim JS, Shin JW. et al. Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo. J Neurol 2013; 260 (03) 832-838 DOI: 10.1007/s00415-012-6712-2.
• 9 Büki B, Ecker M, Jünger H, Lundberg YW. Vitamin D deficiency and benign paroxysmal positioning vertigo. Med Hypotheses 2013; 80 (02) 201-204 DOI: 10.1016/j.mehy.2012.11.029.
• 10 Sheikhzadeh M, Lotfi Y, Mousavi A, Heidari B, Monadi M, Bakhshi E. Influence of supplemental vitamin D on intensity of benign paroxysmal positional vertigo: A longitudinal clinical study. Caspian J Intern Med 2016; 7 (02) 93-98
• 11 Walther LE, Westhofen M. Presbyvertigo-aging of otoconia and vestibular sensory cells. J Vestib Res 2007; 17 (2-3): 89-92
• 12 Lins U, Farina M, Kurc M. et al. The otoconia of the guinea pig utricle: internal structure, surface exposure, and interactions with the filament matrix. J Struct Biol 2000; 131 (01) 67-78 DOI: 10.1006/jsbi.2000.4260.
• 13 Parnes LS, Agrawal SK, Atlas J. Diagnosis and management of benign paroxysmal positional vertigo (BPPV). CMAJ 2003; 169 (07) 681-693
• 14 Jeong SH, Choi SH, Kim JY, Koo JW, Kim HJ, Kim JS. Osteopenia and osteoporosis in idiopathic benign positional vertigo. Neurology 2009; 72 (12) 1069-1076 DOI: 10.1212/01.wnl.0000345016.33983.e0.
• 15 Vibert D, Sans A, Kompis M. et al. Ultrastructural changes in otoconia of osteoporotic rats. Audiol Neurotol 2008; 13 (05) 293-301 DOI: 10.1159/000124277.
• 16 Zucca G, Valli S, Valli P, Perin P, Mira E. Why do benign paroxysmal positional vertigo episodes recover spontaneously?. J Vestib Res 1998; 8 (04) 325-329
• 17 Yu S, Liu F, Cheng Z, Wang Q. Association between osteoporosis and benign paroxysmal positional vertigo: a systematic review. BMC Neurol 2014; 14: 110 DOI: 10.1186/1471-2377-14-110.
• 18 Jang YS, Kang MK. Relationship between bone mineral density and clinical features in women with idiopathic benign paroxysmal positional vertigo. Otol Neurotol 2009; 30 (01) 95-100 DOI: 10.1097/MAO.0b013e31818f5777.
• 19 Bhattacharyya N, Baugh RF, Orvidas L. et al; American Academy of Otolaryngology-Head and Neck Surgery Foundation. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 2008; 139 (05, Suppl 4): S47-S81 DOI: 10.1016/j.otohns.2008.08.022.
• 20 Aguilar del Rey FJ. Protocolo de tratamiento de la deficiencia de vitamina D. [Protocol of treatment of vitamin D deficiency] Med Clin (Barc) 2014; 142 (03) 125-131 DOI: 10.1016/j.medcli.2013.06.012.