Dr. Shivakumar Senniappan1*, Dr. Ruchi Mayank Desai2 ,
Abstract
INTRODUCTION: Benign Paroxysmal Positional Vertigo is one the most common causes of vertigo which has pathophysiology of dislodgement of otoconial particles from the macula and gets accumulated in the semicircular canals. The formation of otoconial particles has been directly affected by Vitamin D as it affects the calcium and phosphate deposition in the bone. The hypocalcaemia associated with Vitamin D deficiency or insufficiency cause degeneration of otoconial particles. Studies have suggested a possible relationship with idiopathic BPPV and altered calcium homeostasis in the endolymph of inner ear.6
METHODS: In our study which was conducted between Jan 2020 to November 2020 we included all the patients with BPPV who also has Vitamin D deficiency and insufficiency. All the patients were diagnosed based on clinical features of BPPV along with levels of Vitamin D. All the patients were given Vitamin D supplementation for three months and were followed up. All the patients were evaluated by VVAS score and the severity and intensity of symptoms were noted and compared before and after Vitamin D supplementation.
RESULTS: In this study 50 patients were included out of which 56% were females and 44% of males. Female predominance was noted in this study. All the patients were in 36 years to 78 years of age. Maximum numbers were in the range of 51 to 70 years of age. The VVAS scores were noted with mean score was 7.4 with standard deviation of 1.2 before treatment and the VVAS score was 3.6 with standard deviation of 0.96. This showed that the severity and the intensity of the symptoms of BPPV reduced with Vitamin D supplementation along with Epleys maneuver.
CONCLUSION: Vitamin D supplementation in patients suffering from BPPV with Vitamin D insufficiency or deficiency resulted in an improvement in the symptomology of the patients as indicated by the comparable VVAS scores making Vitamin D Supplementation an important factor in the management of BPPV along with otoconial repositioning maneuver.
Keywords:
:#
References
1) You P, Instrum R, Parnes L. Benign paroxysmal positional vertigo. Laryngoscope Investig Otolaryngol. 2018 Dec 14;4(1):116-123. doi: 10.1002/lio2.230. PMID: 30828628; PMCID: PMC6383320.
2) Ding J, Liu L, Kong WK, Chen XB, Liu X. Serum levels of 25-hydroxy vitamin D correlate with idiopathic benign paroxysmal positional vertigo. Biosci Rep. 2019;39(4):BSR20190142. Published 2019 Apr 30. doi:10.1042/BSR20190142
3) Çıkrıkçı Işık G, Çevik Y, Emektar E, Çorbacıoğlu ŞK. Analysis of Vitamin D and Calcium Levels in Benign Paroxysmal
Positional Vertigo. Eurasian J Emerg Med 2017; 16: 128-32
4) Pillai NG et al. Int J Otorhinolaryngol Head Neck Surg. 2019 Nov;5(6):1548-1551
Cite this article as: Pillai NG, Gopinath I. A
prospective analysis of vitamin D and recurrent
benign paroxysmal positional vertigo. Int J
Otorhinolaryngol Head Neck Surg 2019;5:1548-51.
5) Hotson JR, Baloh RW. Acute vestibular syndrome.
N Engl J Med. 1998;339(10):680-5.
6) Lundberg Y, Xu Y, Thiessen K, Kramer K.
Mechanism of otoconia and otolith development.
Develop Dynamics. 2014;244(3):239-53.
7)Parham K, Leonard G, Feinn R, Lafereniere D,
Kenny A. Prospective clinical investigation of the
relationship between idiopathic benign paroxysmal
positional vertigo and bone turnover. Laryngoscope.
2013;123(11):2834-9
8) Silva C, Amorim AM, Paiva A. Benign paroxysmal
positional vertigo--a review of 101 cases. Acta
Otorrinolaringol Esp 2015; 66: 205-9.
9) ) 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(07):710–715
10) Walther LE, Westhofen M. Presbyvertigo-aging of otoconia and vestibular sensory cells. J Vestib Res
2007; 17:89–92. PMID: 18413901
11)Parnes LS, Agrawal SK, Atlas J. Diagnosis and management of benign
paroxysmal positional vertigo. CMAJ 2003; 169: 681-93.
12) 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:
237-41.
13)Bu¨ki B, Ecker M, Ju¨nger H, Lundberg YW. Vitamin D deficiency and benign paroxysmal positioning ver
tigo. Med Hypotheses 2013; 80:201–204. https://doi.org/10.1016/j.mehy.2012.11.029 PMID:
23245911
14) 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:
93-8.
15) Gülşah ÇI, Yunsur Ç, Emine E, Şeref KÇ. Analysis of Vitamin D and
Calcium Levels in Benign Paroxysmal Positional Vertigo. Eurasian
J Emerg Med 2017;16:128–132
16) Karataş A, Acar Yüceant G, Yüce T, Hacı C, Cebi IT, Salviz M.
Association of Benign Paroxysmal Positional Vertigo with Osteoporosis and Vitamin D Deficiency: A Case Controlled Study. J Int
Adv Otol 2017;13(02):259–265
17)Sakaida M, Takeuchi K, Ishinaga H, Adachi M, Majima Y. Long-term
outcome of benign paroxysmal positional vertigo. Neurology
2003;60(09):1532–1534
18) 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
19) Pérez P, Franco V, Cuesta P, Aldama P, Alvarez MJ, Méndez JC.
Recurrence of benign paroxysmal positional vertigo. Otol Neurotol 2012;33(03):437–443
