Prevention of recurrent benign paroxysmal positional vertigo with vitamin D supplementation: a meta-analysis

The associations of adherence to the Mediterranean diet with chronic dizziness and imbalance in community-dwelling adults: KNHANES 2019-2021

BACKGROUND

Dizziness and vertigo rank among the top 10 reasons for emergency and clinical referrals to neurologists. Chronic dizziness and imbalance not only reduce quality of life, but also increase mortality. While the Mediterranean diet has long been considered beneficial for human and planetary health, its effects on chronic dizziness or imbalance are understudied. We investigated the associations of adherence to the Mediterranean diet with chronic dizziness and imbalance.

METHODS

This study used data from the Korea National Health and Nutrition Examination Survey 2019-2021 and included 4,183 adults aged 40 years and older with complete information from diet, dizziness, and neurotology questionnaires. The alternate Mediterranean diet score (aMed) for nine food groups was calculated from 24-hour dietary recall data. Based on questionnaire responses, chronic dizziness was categorized as either isolated or chronic dizziness with imbalance, characterized by a cluster of difficulties maintaining a standing position, walking, or falling.

RESULTS

In a multivariable-adjusted model, the prevalence of chronic imbalance was lower in the top aMed tertile than in the bottom tertile (OR 0.37; 95% CI, 0.18-0.74; p-trend = 0.01). Among the individual aMed components, the intake of whole grains and nuts exhibited an inverse relationship with chronic imbalance (OR 0.50; 95% CI, 0.27-0.93 for whole grains; OR 0.55; 95% CI, 0.31-1.01 for nuts). The aMed score was not associated with isolated chronic dizziness.

CONCLUSIONS

Greater adherence to the Mediterranean diet may reduce chronic imbalance, particularly with an adequate intake of whole grains and nuts.

Vestibular function is associated with immune inflammatory response

Association between vestibular function and immune inflammatory response has garnered increasing interest. Immune responses can lead to anatomical or functional alterations of the vestibular system, and inflammatory reactions may impair hearing and balance. Vestibular disorders comprise a variety of conditions, such as vestibular neuritis, benign paroxysmal positional vertigo, Meniere's disease, vestibular migraine, posterior circulation ischemia, and bilateral vestibular disease. Moreover, some patients with autoimmune diseases develop vestibulocochlear symptom. This paper offers an overview of prevalent vestibular diseases and discusses associations between vestibular dysfunction and immune diseases.

Vitamin D Supplementation and Recurrence of Benign Paroxysmal Positional Vertigo

Positional vertigo manifests as a spinning sensation triggered by changes in head position relative to gravity. Benign paroxysmal positional vertigo (BPPV) is an inner ear disorder characterized by recurrent episodes of positional vertigo. The connection between vitamin D insufficiency/deficiency and the onset and recurrence of BPPV is established. This study aims to assess vitamin D as a recurring factor in BPPV and the efficacy of vitamin D supplementation in preventing its recurrence. A comprehensive literature review on the relationship between vitamin D and BPPV recurrence was conducted, searching PubMed, Embase, Web of Science, and article reference lists for studies published from 2020 to 2023. A total of 79 articles were initially identified through the search, with 12 of them being utilized in the study. Recurrence rates for BPPV varied from 13.7% to 23% for studies with follow-up less than 1 year and 13.3% to 65% for studies with follow-up equal to or exceeding 2 years. Risk factors for BPPV recurrence include advanced age, female sex, hypertension, diabetes mellitus, hyperlipidemia, osteoporosis, and vitamin D deficiency. While earlier studies did not establish a link between low vitamin D levels and initial BPPV occurrence, they did associate recurrent episodes with low vitamin D levels. Recent research indicates that vitamin D supplementation in BPPV patients with deficiency or insufficiency decreases both the numbers of relapsing patients and relapses per patient. To validate these findings across diverse populations, further randomized controlled studies with larger cohorts and extended follow-up durations are essential.

Vitamin D supplementation in preventing the recurrence of benign paroxysmal positional vertigo

Objective

To evaluate the effect of vitamin D supplementation on the recurrence rate of benign paroxysmal positional vertigo (BPPV).

Methods

A single-center, prospective, double-blind, placebo-controlled, parallel-group randomized controlled trial was conducted between November 2018 and May 2020. After successful treatment with canalith repositioning maneuvers, patients diagnosed with BPPV were randomized to either the vitamin D (n = 20) or placebo (n = 18) group. Only patients with serum vitamin D levels <20 ng mL-1 were included. The vitamin D group received 7000 IU of vitamin D weekly for a year, while the placebo group received a matching placebo drug. The final endpoint was the BPPV recurrence rate and correlation with serum vitamin D levels after 6 and 12 months in both groups.

Results

Among 38 patients, 37 were followed up for 6 months and 30 for 12 months. Significantly higher serum vitamin D levels were observed in the vitamin D group compared to the placebo group at both the 6-month and 1-year follow-ups (p < .001 at each timepoint). The recurrence rate was lower in the vitamin D group than in the placebo group after 6 months (p = .008) and 1 year (p = .003).

Conclusion

Vitamin D supplementation, in the absence of calcium, may be beneficial for patients prone to recurrent BPPV episodes, particularly when serum vitamin D levels are suboptimal (PRE20181024-001, Clinical Research Information Service, South Korea).

Level of Evidence

1b.

When Particle Repositioning Maneuvers Just Will Not Stick: Clinical Considerations for Persistent Benign Paroxysmal Positional Vertigo

PURPOSE

Although benign paroxysmal positional vertigo (BPPV) is often considered benign and easily treatable, aberrant cases of persistent BPPV can be challenging to manage. Detailed differential diagnosis is essential as central-, vascular-, and cervical-related etiologies may mirror the presentation of persistent BPPV. In addition, an understanding of alternative noninvasive treatment options is important as persistent BPPV is often refractory to traditional particle repositioning maneuvers (PRMs). This article reviews clinical considerations for persistent BPPV.

METHOD

A case of a 68-year-old male diagnosed with posterior semicircular canal BPPV (PC-BPPV) and received various unsuccessful PRMs treatments is described. His clinical presentation is referenced alongside various possible etiologies to discern the most likely diagnosis. Nonsurgical treatment options for intractable PC-BPPV will also be reviewed.

CONCLUSIONS

BPPV recalcitrant to PRM treatment warrants investigation of other etiologies; however, key elements of the case history and objective examination are helpful for differential diagnosis. Brandt-Daroff exercises may facilitate habituation of symptoms secondary to persistent BPPV. More research is needed to understand the use of multiaxial repositioning chairs for the treatment of intractable BPPV.

A Comparison Study of Nutritional Assessment, Diet and Physical Activity Habits, Lifestyle and Socio-Demographic Characteristics in Individuals with and without Dizziness/Vertigo

Dizziness and vertigo are growing health problems and have become responsible for increases in health expenditures. In this context, a case-control study has been conducted by nutritional assessment, including dietary and physical activity habits, lifestyle, and socio-demographic characteristics in adults with (patient group) and without (control group) dizziness or vertigo, and the outcomes were compared between these groups. The patient (n = 150) and control (n = 150) groups included 300 participants. The 24-h Dietary Recall and the food frequency questionnaire (FFQ-21) were conducted in order to gain detailed information about foods and beverages consumed by the participants. Additionally, a questionnaire was completed, assessing general socio-demographic (age, gender, etc.) and lifestyle (smoking, alcohol consumption, and obesity) characteristics, anthropometric measurements, and dietary and physical activity habits. The results revealed that there is an association between dizziness/vertigo and female gender and increasing age. Smoking status and alcohol consumption did not differ between the groups, whereas differences in body mass index and obesity were significantly higher in the patient group (65%; n = 98) than the control group (46%; n = 69) (p = 0.001). Skipping meals "everyday" was significantly high (p = 0.044), and lunch was the most skipped meal in the patient group. The three most preferred cooking methods were oven baking, boiling, and frying for both groups. Daily water intake in the patient group was lower than in the control group (p = 0.026). Dietary intake for carotene and vitamin K were significantly lower in the patient group than the control group, but the opposite was true for vitamin D intake (p < 0.05). Daily consumption of bread and dairy products were highest in the patient group (p < 0.05). The physical activity rate was 35% (n = 53) in the control group and 28% (n = 42) in the patient group. Regular walking was the most preferred activity in both groups (p = 0.037). Active monitoring of individual diet and hydration along with supporting professional counseling are advisable. In addition, a healthy lifestyle including weight control and regular physical activity can be helpful to reduce symptoms of dizziness/vertigo.

Gene expression analysis in recurrent benign paroxysmal positional vertigo: a preliminary study

Objectives

This study aimed to determine the pathophysiology of recurrent benign paroxysmal positional vertigo (BPPV) in young patients using gene expression profiling combined with bioinformatics analysis.

Methods

Total RNA was extracted from the whole blood of four young patients with recurrent BPPV and four controls. The differentially expressed genes (DEGs) between the groups were screened using a microarray analysis based on the cutoff criteria of |log₂ fold change| > 1 and an adjusted p-value of < 0.05. Functional enrichment analysis of DEGs was performed using Gene Ontology analysis, and the protein-protein interaction (PPI) network was constructed using the Search Tool for the Retrieval of the Interacting Genes database.

Results

A total of 39 DEGs were detected between the BPPV and control samples, comprising 33 upregulated DEGs and six downregulated DEGs in the BPPV group. Functional enrichment analysis indicated that the upregulated DEGs were significantly enriched in terms related to metabolic processes and the immune system. Two main pathways were extracted from the PPI network: one was associated with oxidative phosphorylation and stress and the other with the adaptive immune system and extracellular matrix degradation.

Conclusion

The findings of our bioinformatics analysis indicated that oxidative stress or extracellular matrix degradation due to immune-mediated inflammatory responses may contribute to the development of recurrent BPPV in young patients.

Cerebral Outflow Discrepancies in Recurrent Benign Paroxysmal Positional Vertigo: Focus on Ultrasonographic Examination

This prospective pilot study aimed to evaluate whether cerebral inflow and outflow abnormalities assessed by ultrasonographic examination could be associated with recurrent benign paroxysmal positional vertigo (BPPV). Twenty-four patients with recurrent BPPV, affected by at least two episodes, and diagnosed according to American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria, evaluated at our University Hospital, between 1 February 2020 and 30 November 2021, have been included. At the ultrasonographic examination, 22 of 24 patients (92%) reported one or more alterations of the extracranial venous circulation, among those considered for the diagnosis of chronic cerebrospinal venous insufficiency (CCSVI), although none of the studied patients were found to have alterations in the arterial circulation. The present study confirms the presence of alterations of the extracranial venous circulation in recurrent BPPV; these anomalies (such as stenosis, blockages or regurgitation of flow, or abnormal valves, as per the CCSVI) could cause a disruption in the venous inner ear drainage, hampering the inner ear microcirculation and then possibly causing recurrent otolith detachment.

Effect of the serum 25-hydroxyvitamin D level on risk for short-term residual dizziness after successful repositioning in benign paroxysmal positional vertigo stratified by sex and onset age

Objective

A low serum 25-hydroxyvitamin D (25(OH)D) level is relevant to both the occurrence and recurrence of benign paroxysmal positional vertigo (BPPV). However, whether it also contributes to residual dizziness (RD) after successful repositioning maneuvers is unknown. Therefore, this study aimed to explore the correlation between the serum 25(OH)D level and short-term RD severity in patients with BPPV after successful repositioning maneuvers.

Methods

In total, 251 patients with BPPV after successful repositioning were enrolled and prospectively followed up for 1 week (W1). Serum 25(OH)D values were detected by chemiluminescence immunoassay at enrollment (W0). In addition, we explored the relationship between 25(OH)D values at baseline and RD severity at W1 in different subgroups stratified by sex and onset age (early-onset, ≤50 years; late-onset, &gt;50 years).

Results

The serum 25(OH)D level of female patients was significantly lower than that of male patients (15.9 ± 6.8 vs. 19.8 ± 6.6 ng/ml, p &lt; 0.001). Its level also decreased in early-onset patients compared to late-onset ones (15.3 ± 5.9 vs. 18.0 ± 7.3 ng/ml, p = 0.003). In addition, early-onset female patients had lower 25(OH)D values than late-onset female patients (14.0 ± 5.5 vs. 17.1 ± 7.2 ng/ml, p = 0.004). However, this difference was not observed between early- and late-onset male patients. Among early-onset female patients, the 25(OH)D values of the moderate-to-severe RD group were lower than those of the minor or no RD group (10.9 ± 3.3 vs. 14.7 ± 5.7 vs. 15.0 ± 5.9 ng/ml, p = 0.046). Multivariate analysis found that decreased 25(OH)D values were related to the occurrence of moderate-to-severe RD in early-onset female patients (OR = 0.801; p = 0.022). This effect did not exist in late-onset female or male patients with BPPV.

Conclusions

Age and sex differences in serum 25(OH)D levels exist in patients with BPPV. A decreased 25(OH)D level in early-onset female patients may increase the odds of moderate-to-severe RD 1 week after successful repositioning maneuvers.

The Impact of the Angular Head Movement's Velocity during Diagnostic Maneuvers on Proper Benign Positional Paroxysmal Vertigo Diagnosis and Therapy

Based on the current state of the BPPV field, there are no guidelines that specify an angular head movement's velocity (AHMV) during diagnostic maneuvers of BPPV. The aim of this study was to evaluate the impact of AHMV during diagnostic maneuvers on proper BPPV diagnosis and therapy. The analysis covered the results obtained in 91 patients with a positive result of the Dix-Hallpike (D-H) maneuver or the roll test. The patients were divided into four groups based on values of AHMV (high 100-200°/s and low 40-70°/s) and the BPPV type (posterior: PC-BPPV or horizontal: HC-BPPV). The parameters of the obtained nystagmuses were analyzed and compared to AHMV. There was a significant negative correlation between AHMV and latency of nystagmus in all study groups. Furthermore, there was a significant positive correlation between AHMV and both maximum slow phase velocity and average frequency of nystagmus in the PC-BPPV groups, whereas it was not observed in the HC-BPPV patients. Complete relief of symptoms was reported after 2 weeks and was better in patients diagnosed with maneuvers performed with high AHMV. High AHMV during the D-H maneuver allows the nystagmus to be more visible, increasing the sensitivity of diagnostic tests and is crucial for a proper diagnosis and therapy.

Prevention of Recurrent Benign Paroxysmal Positional Vertigo: The Role of Combined Supplementation with Vitamin D and Antioxidants

Benign paroxysmal positional vertigo (BPPV) usually has a favorable course, although it is possible to observe BPPV with a high recurrence rate. Previous studies suggested that vitamin D deficiency might affect BPPV recurrences, and oxidative stress might play a complementary role in BPPV pathogenesis. This multicentric trial aimed to evaluate the effectiveness of oral nutritional supplementation with a compound of alpha-lipoic acid, Carnosine, and Zinc (LICA® (Difass International, Coriano (RN), Italy)), vitamins of group B and vitamin D in preventing BPPV recurrences. A total of 128 patients with high recurrence-BPPV were randomized in three arms: Arm 1 consisted of subjects with “insufficient” or “deficient” vitamin D blood levels, treated with daily oral supplementation of LICA®, vitamins of group B and vitamin D3 (800 UI), Arm 2 included BPPV subjects with “sufficient” vitamin D who did not receive any nutritional support, and Arm 3 included subjects with a “sufficient” serum concentration of vitamin D who received supplementation with a compound of LICA® and Curcumin. After six months of follow-up, a significant reduction of BPPV relapses compared to the baseline was found only in Arm 1 (−2.32, 95% CI: 3.41−1.62, p-value < 0.0001). Study results suggested that oral nutritional supplementation with vitamin D3 plus antioxidants can prevent relapses in patients suffering from high recurrence-BPPV.

[Serum 25-hydroxyvitamin D expression and its correlation in patients with vestibular neuritis]

Objective:To investigate the expression level of serum 25-（OH） D and its correlation in patients with vestibular neuritis（VN）. Methods:30 acute VN patients and 50 age-and sex-matched healthy controls who attended the Otolaryngology, Head and Neck Surgery Department of the First Hospital of Shanxi Medical University from October 2020 to October 2021 were selected. The demographic and clinical data of all subjects were recorded, the levels of serum 25-（OH） D and inflammatory markers were measured and compared, and the changes of serum 25-（OH） D levels in convalescent patients with VN were followed up. Results:The serum level of 25-（OH） D in the acute phase VN group was significantly lower than that in healthy controls[（10.14±2.92） ng/mL vs （20.61±4.70） ng/mL, P<0.01], and the deficiency rate of 100.0%（30/30） was significantly higher than 54.0%（27/50）. Moreover, the serum level of 25-（OH） D in the recovery period（3 months later） was significantly higher[（10.14±2.92） ng/mL vs （15.94±4.88） ng/mL, P<0.01], and the deficiency rate was significantly decreased by 76.7%（23/30）. However, the serum 25-（OH） D level was significantly lower in both the VN group than that in both the acute period and the recovery group, and the deficiency rate was significantly higher than that in the control group. Multivariate binary Logistic regression model analysis showed that low-level serum 25-（OH） D was associated with the onset of VN, with an OR value of 0.193（95%CI=0.043-0.861, P=0.031）. In addition, the results of this study showed that peripheral blood leukocyte（WBC） and neutrophil / lymphocyte ratio（NLR） levels in the acute VN group were significantly higher than in healthy controls[（7.65±3.02） ×10⁸/L vs （5.50±2.50） ×10⁸/L, P<0.01; （2.46±2.95） ×100% vs（1.67±0.92） ×100%, P<0.01 ], and there was no significant difference in Platelet / lymphocyte ratio（PLR） and and average platelet volume（MPV） levels in the two groups（P>0.05）. There were no significant differences in age distribution, sex ratio, body mass index, persistent health problems, or lifestyle groups（P>0.05）. Conclusion:This study is the first to detect serum 25-（OH） D level and inflammation index level, and dynamically assess the serum 25-（OH） D level in different stages, found that low serum 25-（OH） D is associated with the onset of VN, physiological concentration of serum 25-（OH） D is a protective factor of VN, vitamin D supplementation therapy may be a new target of VN treatment.

Vitamin D Supplementation for Benign Paroxysmal Positional Vertigo: A Systematic Review

OBJECTIVE

Benign paroxysmal positional vertigo (BPPV) is commonly attributed to displaced otoconia. These have been shown to have biomineralization close to that of bone, and vitamin D deficiency has been associated with BPPV. We aim to systematically review the available literature on vitamin D supplementation and BPPV intensity and recurrence in adults.

DATABASES REVIEWED

PubMed, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Current Controlled Trials, and ClinicalTrials.gov.

METHODS

We systematically reviewed the available literature from 1947 to April 2020. The study protocol was registered in the PROSPERO database (trial registration: CRD42020183195).

RESULTS

A total of 179 abstracts were identified and screened by two independent reviewers. Based on inclusion and exclusion criteria, six studies were selected and subjected to a quality assessment. In one randomized clinical trial (RCT), vitamin D supplementation was found to reduce annual recurrence rate of vertigo in patient with BPPV and subnormal serum vitamin D levels compared with placebo (odds ratio, 0.69; 95% confidence interval, 0.54-0.90). Non-RCTs demonstrated the possibility of a null effect in the random effects model (odds ratio, 0.08; 95% confidence interval, 0.00-1.56). The RCT considered as low risk of bias. All of the nonrandomized studies were assessed as serious risk of bias.

CONCLUSIONS

The intervention studies identified consistently demonstrated a decrease in BPPV recurrence with supplementation of vitamin D in patients with subnormal vitamin D levels. Although there is a paucity of high-quality studies, the present literature does highlight a role for optimization of vitamin D levels in patients with BPPV.

[Diagnosis and rehabilitation of anterior canal benign paroxysmal positional vertigo]

OBJECTIVE

To develop a method for predicting otolithiasis recurrence within 1 year after benign paroxysmal positional vertigo (BPPV) episode based on analysis of the anamnesis and standardized characteristics of the clinical symptoms and treatment of the disease.

MATERIAL AND METHODS

The study included 640 patients with BPPV, who were divided into two groups: the 1st group (n=458) - patients with no recurrence in 1 year of follow-up; the 2nd group (n=148) - patients with recurrence in the first year after treatment of BPPV episode. In order to identify risk factors, the initial clinical and anamnestic features associated with BPPV (gender, age, comorbidities), clinical symptoms and rehabilitation parameters of the last episode of the disease were analyzed. Diagnostic indices were calculated for the sets of selected features that reliably distinguished both groups of patients with absent/present BPPV recurrence within one year, and based on these, an algorithm was created using a Bayesian sequential diagnostic procedure to predict BPPV recurrence within 1 year of an identified and treated BPPV episode.

RESULTS

In the 2nd group there was the significant prevalence of elderly (older 65 years) and female patients. In these patients higher association with hypertension, type II diabetes mellitus, neurological diseases, osteoporosis and lung diseases was observed. Diagnosis and treatment of recurrent patients in the 2nd group correlates with detection of horizontal nystagmus in Dix-Hallpike test in case of horizontal canal BPPV, requirement for several maneuvers per appointment, canal switch during reposition, resistant course of the disease, the need for additional self-treatment for patients between appointments, and the more frequent development of residual vertigo. Prognostic algorithm for predicting recurrence within 1 year of detected and treated posterior and horizontal canal BPPV episode was developed with a prediction accuracy of 75.3% (71.3%; 79%) and 79.4% (71.6%; 85.9%), respectively.

CONCLUSION

The use of the algorithm proposed by us will allow not only to prevent the identified risk factors, but also to inform the patient in a timely and sufficient manner about the likelihood of a relapse of the disease in order to prevent the development of functional vertigo, as well as training in universal repositional maneuvers before a repeat consultation of specialist.

Characteristics of bone metabolism in postmenopausal female patients with different types of idiopathic benign paroxysmal positional vertigo: A single-centre retrospective study

OBJECTIVE

The association between benign paroxysmal positional vertigo (BPPV) and impaired calcium metabolism has attracted widespread interest. Several studies have suggested that decreased bone mineral density (BMD) and serum 25-hydroxyvitamin D (25(OH)D) level are related to the occurrence and/or recurrence of BPPV; however, the characteristics of bone metabolism in patients with BPPV subtypes have not been fully investigated, and conclusions have been controversial. This study aimed to evaluate BMD and serum levels of 25(OH)D and bone turnover markers to clarify the characteristics of bone metabolism in patients with different types of BPPV.

METHOD

We retrospectively analysed the data of new-onset idiopathic postmenopausal female patients with BPPV at our institution from January 2016 to January 2020. The patients' demographic data including age, medication history, concomitant diseases, onset time, clinical form, laboratory indicators, such as serum levels of 25(OH)D, bone formation markers, namely, amino-terminal propeptide of type I procollagen (PINP) and osteocalcin (OC), bone resorption marker, namely, β-isomerized carboxy-terminal telopeptide of type I collagen (β-CTX), and BMD were collected and analysed.

RESULTS

This study included 201 consecutive postmenopausal female patients with BPPV. Among them, 138 were diagnosed with posterior semicircular canal BPPV, 42 were diagnosed with lateral semicircular canal canalolithiasis, and 21 were diagnosed with lateral semicircular canal cupulolithiasis. There were no significant differences in age distribution, body mass index, clinical history, levels of albumin, globulin, uric acid, creatinine, or blood urea nitrogen, lipid profiles (except high-density lipoprotein cholesterol) and routine blood parameters among these groups (P > 0.05). There were no significant differences in the mean T-score and BMD values of different sites or in the serum levels of 25(OH)D and bone turnover markers (PINP, OC and β-CTX) among the subgroups (P > 0.05). The proportion of reduction in BMD (T-score < -1 SD) and decreased serum vitamin D level (< 20 ng/ml) were not significantly different between the subgroups (P > 0.05).

CONCLUSION

There were no significant differences in bone metabolism in postmenopausal female patients with different types of idiopathic BPPV.

Relationship between calcium metabolism and benign paroxysmal positional vertigo in north Sardinia population

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.

Update on benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo worldwide. This review considers recent advances in the diagnosis and management of BPPV including the use of web-based technology and artificial intelligence as well as the evidence supporting the use of vitamin D supplements for patients with BPPV and subnormal serum vitamin D.