The effect of serum vitamin D normalization in preventing recurrences of benign paroxysmal positional vertigo: A case-control study
Mahboobeh Sheikhzadeh, Yones Lotfi, Abdollah Mousavi, Behzad Heidari, Enyatollah Bakhshi, Mahboobeh Sheikhzadeh, Yones Lotfi, Abdollah Mousavi, Behzad Heidari, Enyatollah Bakhshi
Abstract
Background: Benign paroxysmal positional vertigo (BPPV) is a condition with recurrent attacks in a significant proportion of patients. The present case- control study was conducted to assess the influence of serum vitamin D normalization on recurrent attacks of vitamin D deficient patients.
Methods: Diagnosis of BPPV was made based on history and clinical examination and exclusion of other conditions. Serum 25-hydroxy vitamin D (25-OHD) was measured using ELISA method and a levels of < 20 ng/ml was considered a deficiency of vitamin D. Inclusion criteria were as follows: history of recurrent attacks and serum 25-OHD<20.ng/ml. While the patients with history of trauma, surgery and chronic systemic diseases were excluded. The patients were classified into two groups: treatment and control, intermittently. Both groups received Epley rehabilitation therapy one session per week for 4 weeks but the treatment group received an additional supplement of 50.000 IU of vitamin D (cholecalciferol) weekly for two months to achieve serum 25-OHD ≥ 30 ng/ml and the study patients were followed-up for 6 months.
Results: Twenty-seven patients were allocated to each group. At baseline, serum 25-OHD was similar (10.7±2.3 vs 11.41±1.9, P=0.23). At month 2, serum 25-OHD in the treatment group increased significantly to ≥ 30 ng/ ml, whereas serum 25-OHD in the control group remained unchanged (34.2±3.3 vs 10.6 10.6±2.2 ng/ml, P=0.001). During the follow-up period, attacks of BPPV in the treatment group decreased significantly compared with the control group (14.8% vs 96.3% OR= 0.18, P=0.001).
Conclusion: The findings of this study indicate that the normalization of serum vitamin D significantly reduces BPPV recurrences.
Keywords: 25-hydroxy vitamin D; BPPV; Epley Therapy; Recurrent vertigo.
References
- Von Brevern M, Radtke A, Lezius F, et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry. 2007;78:710–5.
- Gámiz MJ, Lopez-Escamez JA. Health-related quality of life in patients over sixty years old with benign paroxysmal positional vertigo. Gerontology. 2004;50:82–6.
- Oghalai JS, Manolidis S, Barth JL, Stewart MG, Jenkins HA. Unrecognized benign paroxysmal positional vertigo in elderly patients. Otolaryngol Head Neck Surg. 2000;122:630–4.
- Lopez-Escamez JA, Gamiz MJ, Fernandez-Perez A, Gomez-Fiñana M. Long-term outcome and health-related quality of life in benign paroxysmal positional vertigo. Eur Arch Otorhinolaryngol. 2005;262:507–11.
- Pérez P, Franco V, Cuesta P, et al. Recurrence of benign paroxysmal positional vertigo. Otol Neurotol. 2012;33:437–43.
- Silva C, Amorim AM, Paiva A. Benign paroxysmal positional vertigo--a review of 101 cases. Acta Otorrinolaringol Esp. 2015;66:205–9.
- Brandt T, Huppert T, Hufner K, et al. Long-term course and relapses of vestibular and balance disorders. Restor Neurol Neurosci. 2010;28:69–82.
- Hilton B, Pinder DK. The Epley (canalith repositioning) maneuver for benign paroxysmal positional vertigo. Cochrane Database Syst Rev. 2014;12:CD003162.
- Nunez RA, Cass SP, Furman JM. Short- and long-term outcomes of canalith repositioning for benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2000;122:647–52.
- West N, Hansen S, Møller MN, Bloch SL, Klokker M. Repositioning chairs in benign paroxysmal positional vertigo: implications and clinical outcome. Arch Otorhinolaryngol. 2015 [Epub ahead of print]
- Büki B, Ecker M, Jünger H, Lundberg YW. Vitamin D deficiency and benign paroxysmal positioning vertigo. Med Hypotheses. 2013;80:201–4.
- Jeong SH, Kim JS, Shin JW, et al. Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo. J Neurol. 2013;260:832–8.
- 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;272:2249–53.
- Monadi M, Heidari B, Asgharpour M, et al. Relationship between serum vitamin D and forced expiratory volume in patients with chronic obstructive pulmonary disease (COPD) Caspian J Intern Med. 2012;3:451–5.
- Heidari B. Knee osteoarthritis diagnosis, treatment and associated factors of progression: Part II. Caspian J Inter Med. 2011;2:249–55.
- Heidari B. Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Caspian J Intern Med. 2011;2:205–12.
- Heidari B, Heidari P, Tilaki KH. Relationship between unexplained arthralgia and vitamin D deficiency: a case control study. Acta Med Iran. 2014;52:400–5.
- Heidari B, Heidari P, Hajian-Tilaki K. High prevalence of vitamin D deficiency in women presenting to rheumatology clinic in north of Iran: An inverse relation with age. J Womens Health Care. 2013;2:123.
- Heidari B, Javadian Y, Babaei M, et al. Restorative effect of vitamin D deficiency on knee pain and quadriceps muscle strength in knee osteoarthritis. Acta Med Iran. 2015;53:466–70.
- Talaat HS, Kabel AH, Khaliel LH, et al. Reduction of recurrence rate of benign paroxysmal positional vertigo by treatment of severe vitamin D deficiency. Auris Nasus Larynx. 2015 Sep 16; pii: S0385-8146(15)00203-5. [Epub ahead of print]
- Heidari B, Heidari P, Samari E, Jalali MR. Frequency of vitamin D deficiency in common musculoskeletal conditions. J Babol Univ Med Sci. 2014;16:7–15.
- Taneja MK, Taneja V. Vitamin d deficiency in E.N.T. Patients. Indian J Otolaryngol Head Neck Surg. 2013;65:57–60.
- Parham K, Leonard G, Feinn RS, Lafreniere D, Kenny AM. Prospective clinical investigation of the relationship between idiopathic benign paroxysmal positional vertigo and bone turnover: a pilot study. Laryngoscope. 2013;123:2834–9.
- Heidari B, Heidari P, Nourooddini HG, Hajian-Tilaki KO. Relationship between parity and bone mass in postmenopausal women according to number of parities and age. J Reprod Med. 2013;58:389–94.
- Heidari B, Hoshmand S, Hajian K, Heidari P. Comparing bone mineral density in postmenopausal women with and without vertebral fracture and its value in recognizing high-risk individuals. East Mediterr Health J. 2010;16:868–73.
- Yamanaka T, Shirota S, Sawai Y, et al. Osteoporosis as a risk factor for the recurrence of benign paroxysmal positional vertigo. Laryngoscope. 2013;123:2813–6.
- Liao WL, Chang TP, Chen HJ, et al. Benign paroxysmal positional vertigo is associated with an increased risk of fracture: a population-based cohort study. J Orthop Sports Phys Ther. 2015;45:406–12.
- Yu S, Liu F, Cheng Z, Wang Q. Association between osteoporosis and benign paroxysmal positional vertigo: a systematic review. BMC Neurol. 2014;14:110.
- Heidari B. Muscle strength, vitamin D deficiency and knee osteoarthritis. J Babol Univ Med Sci. 2012;14:84–91.
- Hajian-Tilaki K, Heidari B, Firouzjahi A, et al. Prevalence of metabolic syndrome and the association with socio-demographic characteristics and physical activity in urban population of Iranian adults: a population-based study. Diabetes Metab Syndr. 2014;8:170–6.
- Heidari B, Haji Mirghassemi MB. Seasonal variations in serum vitamin D according to age and sex. Caspian J Intern Med. 2012;3:535–40.
Source: PubMed