Assessment of vitamin D deficiency in recurrent BPPV patients: A cross-sectional study

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.

Clinical characteristics of benign paroxysmal positional vertigo after traumatic brain injury

INTRODUCTION

The aim of the present study was to evaluate the characteristics of brain injury and to assess the relationship between them and treatment outcomes in patients with traumatic benign paroxysmal positional vertigo (t-BPPV).

MATERIALS AND METHODS

Sixty-three consecutive patients who were diagnosed with BPPV within 2 weeks after head trauma were included.

RESULTS

Cerebral concussion, intracranial hemorrhages (ICH), skull fracture without ICH, and hemorrhagic contusion were observed in 68%, 24%, 5%, and 3% of t-BPPV patients, respectively. BPPV with single canal involvement was observed in 52 (83%) patients and that with multiple canal involvement was observed in 11 (17%) patients. The number of treatment sessions was not significantly different according to the cause of head trauma (p = 0.252), type of brain injury (p = 0.308) or location of head trauma (p = 0.287). The number of recurrences was not significantly different according to the cause of head trauma (p = 0.308), type of brain injury (p = 0.536) or location of head trauma (p = 0.138).

CONCLUSION

The present study demonstrated that there were no significant differences in treatment sessions until resolution and the mean number of recurrences according to the type of brain injury.

Correlation of idiopathic benign paroxysmal positional vertigo with cerebral small vessel disease

BACKGROUND

Benign paroxysmal positional vertigo (BPPV) is the most prevalent form of peripheral vertigo, with vascular lesions being one of its suspected causes. The older adults are particularly vulnerable to BPPV. Cerebral small vessel disease (CSVD), on the other hand, is a clinical condition that results from damage of cerebral small vessels. Vascular involvement resulting from age-related risk factors and proinflammatory state may act as the underlying factor linking both BPPV and CSVD.

AIM

The objective of this study is to explore the potential correlation between BPPV and CSVD by examining whether individuals aged 50 and older with BPPV exhibit a greater burden of CSVD.

MATERIALS AND METHODS

This retrospective study included patients aged 50 years and older who had been diagnosed with BPPV. A control group consisting of patients diagnosed with idiopathic facial neuritis (IFN) during the same time period was also included. The burden of cerebral white matter hyperintensities (WMHs) was evaluated using the Fazekas scale. An ordinal regression analysis was conducted to investigate the potential correlation between BPPV and WMHs.

RESULTS

The study included a total of 101 patients diagnosed with BPPV and 116 patients with IFN. Patients with BPPV were found to be significantly more likely (OR = 2.37, 95% CI 1.40-4.03, p = 0.001) to have a higher Fazekas score compared to the control group. Brain infarctions, hypertension, and age were all identified as significant predictors of white matter hyperplasia on MRI, with OR of 9.9 (95% CI 4.21-24.84, P<0.001), 2.86 (95% CI 1.67-5.0, P<0.001), and 1.18 (95% CI 1.13-1.22, P<0.001) respectively.

CONCLUSION

Our findings suggest that vascular impairment caused by age-related risk factors and proinflammatory status may be contributing factors to the development of BPPV in individuals aged 50 and above, as we observed a correlation between the suffering of BPPV and the severity of WMHs.

Low vitamin D and uric acid status in patients with benign paroxysmal positional vertigo

PURPOSE

Growing evidence reported that vitamin D and uric acid metabolism played roles in the occurrence of benign paroxysmal positional vertigo, an otoconia-related vestibular disorder. We aimed to investigate the serum 25-hydroxy vitamin D (25(OH)D) and uric acid in patients with benign paroxysmal positional vertigo and to determine the risk factor for benign paroxysmal positional vertigo.

METHODS

This case-control study comprised 182 patients with benign paroxysmal positional vertigo and 182 age- and gender-matched controls. All subjects' age, body mass index, systolic blood pressure, diastolic blood pressure, 25-hydroxyvitamin D (25(OH)D), uric acid and serum calcium measurements were analyzed.

RESULTS

We found a female preponderance of benign paroxysmal positional vertigo patients, with a median of 60 (52-66) years old. The results showed low vitamin D status both in benign paroxysmal positional vertigo and controls, with no significant difference of 25(OH)D levels between benign paroxysmal positional vertigo patients and controls (P > 0.05). Compared with the control group, patients with benign paroxysmal positional vertigo had a higher prevalence of vitamin D deficiency and a lower prevalence of vitamin D sufficiency (P < 0.05). Uric acid was significantly lower in the benign paroxysmal positional vertigo groups (P < 0.05). Logistic regression analysis revealed that age and uric acid were considered higher risk predictors for benign paroxysmal positional vertigo.

CONCLUSION

Our study observed low vitamin D status in patients with benign paroxysmal positional vertigo, with no significant differences of the 25(OH)D level in patients with benign paroxysmal positional vertigo and controls. Elderly, vitamin D deficiency and low uric acid levels may be risk factors for benign paroxysmal positional vertigo occurrence.

Benign Paroxysmal Positional Vertigo Is Associated with an Increased Risk for Migraine Diagnosis: A Nationwide Population-Based Cohort Study

Previous studies reported an increased risk of benign paroxysmal positional vertigo (BPPV) in patients with migraine. Hence, we aimed to assess the risk of migraine in patients with BPPV. This cohort study was conducted using the Taiwan National Health Insurance Research Database. The BPPV cohort consisted of patients aged <45 years with a diagnosis of BPPV between 2000 and 2009. An age- and sex-matched comparison group free from a history of BPPV or migraine was selected. All cases were followed up from 1 January 2000 to 31 December 2010 or until death or a diagnosis of migraine. The baseline demographic characteristics in both groups were compared using Student's t-test and the chi-square test. Cox proportional hazards regression analysis was used to estimate the hazard ratio for migraine in the BPPV cohort compared with the comparison group after adjustment for age, sex, and comorbidities. Notably, 117 of the 1386 participants with BPPV and 146 of the 5544 participants without BPPV developed migraine. After adjustment for age, sex, and comorbidities, BPPV showed an adjusted hazard ratio indicating a 2.96-fold increased risk of migraine (95% confidence interval: 2.30-3.80, p < 0.001). We found that BPPV is associated with an increased risk of a migraine diagnosis.

[Dizziness]

Dizziness is a frequently occurring problem with a negative influence on quality of life. In this article, the most common causes of dizziness are discussed on the basis of practical questions from clinical practice. The importance of a structured anamnesis is reviewed. The clinical syndrome of benign paroxysmal positional vertigo and its treatment are covered extensively. Red flag symptoms of acute vestibular syndrome are specified, as well as symptoms that justify referral from primary to secondary care.

Is Inadequate Water Intake a Risk Factor for Vestibular Disorders?

BACKGROUND

Water is a vital nutrient for the human body system and failing to consume enough water could cause health problems. The purpose of this study is to investigate the relationship between water intake and vestibular system disorders.

METHODS

Data from 93 patients (aged between 20 and 76 years) with vestibular disorders were analyzed in the study. The mean age of the patients was 46.96 ±13.94 years (female: 45.68 ±13.45, male: 49.96 ±14.85), and 69.9% (n=65) were female. Participants were sub-categorized into diagnostic groups as follows: benign paroxysmal positional vertigo, Meniere's disease, vestibular neuritis, vestibular migraine, and persistent postural perceptual dizziness. The water intake information was analyzed for total water, plain water, and caffeinated beverages separately and compared between groups.

RESULTS

There was a significant difference between vestibular neuritis and benign paroxysmal positional vertigo (P < .001) and also between vestibular neuritis and Meniere's disease (P = .021) in terms of the intake values of plain water and total water. No significant difference was found between groups in caffeinated beverages intake (P = .151), and it was found that there is no statistically significant difference in plain water and total water intake in terms of gender (P > .05).

CONCLUSION

The most significant result of this study is that inadequate water intake can be a risk factor for some forms of peripheral vestibular disorders. People should be informed about the importance of drinking water and be encouraged to increase their water intake.

The role of low levels of vitamin D as a co-factor in the relapse of benign paroxysmal positional vertigo (BPPV)

BACKGROUND

Benign paroxysmal positional vertigo is characterized as brief episodes of vertigo that are exacerbated by the unexpected act of moving to a current provoking location. It is thought to be an otoconia-related balance disorder. Our objectives were to assess the serum concentrations of vitamin D and calcium (total and ionized) in cases with BPPV, determine if low vitamin D levels were regarded as a cause for BPPV relapse, and determine whether vitamin D supplementation would minimize the risk of BPPV relapse.

RESULTS

Sixty cases with BPPV were included in the study; 53 cases had posterior canal BPPV, while seven had lateral canal BPPV. Canalithiasis was the most common type of BPPV pathology. Forty cases had abnormally low levels of vitamin D. There was a statistically significant positive correlation between the mean vitamin D assay for all cases with BPPV and serum calcium. There was statistically significant difference in comparing the relapse of BPPV for group that receive vitamin D after one year follow up.

CONCLUSION

Abnormal vitamin D levels were linked with the incident and relapse of BPPV. Correction of low vitamin D levels was linked with the reduction of the relapse of BPPV.

Effect of vitamin D supplementation on benign paroxysmal positional vertigo recurrence: A meta-analysis

Benign paroxysmal positional vertigo is characterized by recurrence, which exposes patients to repeated vertigo attacks. Vitamin D deficiency has been found to be a risk factor in benign paroxysmal positional vertigo, although effect of its elimination on recurrence reduction remains unknown. To determine the effect of vitamin D supplementation in preventing recurrence of benign paroxysmal positional vertigo patients with vitamin D deficiency using a meta-analysis study. We searched and retrieved relevant articles from several databases, then used the Cochrane evaluation system or Methodological Index for Non-Randomized Studies (MINORS) to assess the quality of studies. We adopted risk-ratio (RR) with corresponding 95% confidence interval (CI) to determine effect sizes, and further performed statistical analyses under a randomized- or fixed-effects model. Seven studies, comprising 602 and 731 participants in the case and control group respectively, met our inclusion criteria, and were therefore included in the meta-analysis. Assessment based on Cochrane evaluation system or MINORS revealed that most of the studies had high quality. Moreover, the randomized- model revealed that the vitamin D supplementation group had a lower recurrence rate than the control group which did not accepted vitamin D supplementation (RR = 0.41, 95% CI = 0.26-0.65, p < 0.01). Overall, these findings indicate that vitamin D supplementation can significantly lower recurrence in benign paroxysmal positional vertigo and vitamin D deficiency.

[Post-traumatic benign paroxysmal positional vertigo; an underdiagnosed cause of dizziness following trauma]

Dizziness is a frequently reported symptom following head trauma. Although often ascribed to concussion, post-traumatic benign paroxysmal positional vertigo (BPPV) must be included in the differential diagnosis. In this article, three patients who attended a neurology outpatient clinic with persistent dizziness following head trauma were ultimately diagnosed with post-traumatic BPPV. Dizziness lessened substantially once a canalith repositional manoeuvre was performed. Patients with post-traumatic BPPV are generally younger, report more severe symptoms and have a higher rate of relapse. Diagnosing post-traumatic BPPV can be challenging due to the presence of more urgent injuries in the initial phase and the habitual attribution of symptoms to concussion. A timely diagnosis is crucial, however, since treatment is easy to perform, non-invasive and effective.

[Clinical study of inner ear hemorrhage-associated sudden deafness and vertigo]

Objective: To analyze the clinical features and possible pathogenesis of sudden deafenss and vertigo induced by inner ear hemorrhage. Methods: Clinical data of 30 patients with inner ear hemorrhage, from the first affiliated hospital of Sun Yat-sen university during Jan 2016 to May 2017, were retrospectively analyzed. Results: Vergito and profound deafness were seen in all patients. The duration of vertigo ranged from 24 hours to three days in 11 cases, three to 14 days in the remaining 19 cases. Simultaneous occurrence of vergito and deafenss were seen in 24 patients. Semicircular canal hypofunction and abnormal cervical vestibular evoked myogenic potentials(C-VEMP)/ocular vestibular evoked myogenic potentials(O-VEMP) were detected in all cases. Ten patients had benign paroxysmal positional vertigo(BPPV) simultaneously. Hearing recovered in 20% of the cohort posttreatment. Dizziness and balance disturbance disappeared 1 to 2 months after therapy in 16 cases. Long term (6 months) follow up revealed poor hearing outcome and vestibular rehabilitation. Conclusion: Vestibular vertigo and profound sensorineural hearing loss, with unsatisfactory clinical prognosis, constituted the characters of inner ear hemorrhage-associated sudden deafness.

[Benign paroxysmal positional vertigo as a complication of head trauma]

Head trauma is the most frequent cause of benign paroxysmal positional vertigo (BPPV) in patients younger than 50 years, and finding the aetiology of post-traumatic dizziness can be challenging. This case report presents a 45-year-old male patient suffering from positional dizziness after head trauma. He was diagnosed in a reposition chair, after manual manoeuvres had failed to provide the diag-nosis. The role of a reposition chair in diagnosing post-traumatic BPPV has not been demonstrated before, and this case illustrates, how the chair can help to clarify the diagnosis.

[Benign paroxysmal positional vertigo is an overlooked complication of head trauma]

Head trauma can cause benign paroxysmal positional vertigo (BPPV) and may be an overlooked complication. This is a review of the literature on BPPV following head trauma. Studies indicate, that 11-57% of patients with vertigo after head trauma can be diagnosed with BPPV. BPPV occurs after mild to severe head trauma. The reposition chair is expected to help diagnosing and treating patients with traumatic BPPV, particularly in more resistant cases. Outreach efforts towards this group of patients could decrease the number of sick days.

Isolated horizontal canal hypofunction differentiating a canalith jam from an acute peripheral vestibular loss

OBJECTIVES

To describe a unique case of acute vertigo presenting with spontaneous horizontal nystagmus (SHN) and a clinical picture consistent with right acute peripheral vestibular loss (APVL) in which an isolated hypofunction of a horizontal semicircular canal (HSC) permitted to detect a spontaneous canalith jam and treat the patient accordingly.

METHODS

Case report and literature review.

RESULTS

A 74-year old woman presented with acute vertigo, left-beating SHN and a clinical picture consistent with right APVL. Nevertheless, vestibular evoked myogenic potentials were normal with symmetrical amplitudes and the video head impulse test (vHIT) revealed an isolated hypofunction of the right HSC. After repeated head shakings, the supine roll test evoked bilaterally a positioning paroxysmal geotropic horizontal nystagmus suggesting benign paroxysmal positional vertigo involving the non-ampullated arm of the right HSC. vHIT and caloric testing confirmed restitution of HSC function after repositioning maneuvers.

CONCLUSIONS

In case of acute vertigo with SHN, a complete functional assessment of vestibular receptors and afferents should always be given in order to avoid misdiagnosis. Canalith jam should be considered in case of spontaneous nystagmus and isolated canal hypofunction.

[Treatment of patients with probable benign paroxysmal positional vertigot]

Objective:To study the treatment and outcome of the patients with probable BPPV who lacked typical nystagmus.Method： Nine hundred and twenty-two patients with posterior canal BPPV or lateral canal BPPV were selected from the database of our department. There were 801 patients with typical nystagmus during positional testing and 121 patients lacked of typical nystagmus. Manual reposition (Eply,modified Semount,Barbecue and Li manuve) were used and the follow-up was（3.7±2.5）days.Result：In the patients with probable BPPV,there were 44 patients affected by posterior canal and 77 patients had been affected by lateral canal.In the patients with definite BPPV,there were 489 patients affected by posterior canal and 312 by horizontal canal.There was no statistic difference in the result of the treatment (cure,relief and no response) between the probable BPPV and definite BPPV (P>0.05).However,the rate of 'cure' and 'relief' in the probable BPPV was higher than the definite BPPV in lateral canal (P=0.023).Conclusion:A few patients with probable BPPV may develop to definite BPPV or other disease with dizziness.Maneuver of reposition is meaningful for probable BPPV,especially for patients with lateral canal probable BPPV.

In whom does horizontal canal BPPV recur?

PURPOSE

The objective of this study is to examine the rate of horizontal canal BPPV recurrence of the same type and search for predisposing factors.

[Etiological characteristics analysis of 3 137 outpatients with vertigo or dizziness in ENT department]

Objective: To analyze the etiological characteristics of patients in department of ENT with chief complaint of vertigo or dizziness in order to reduce the rate of misdiagnosis and wrong treatment. Method: A total of 3 137 patients in department of ENT with chief complaint of vertigo or dizziness from Sep 2015 to Sep 2017 were included and the etiologies were clarified retrospectively. And in which with any of the 8 kinds of disease including benign paroxysmal positional vertigo(BPPV), vestibular neuritis, vestibular migraine (VM), Meiniére disease, recurrent vestibular disease, sudden deafness with vertigo, psychogenic vertigo, posterior circulation ischemia (PCI) together 2 138 patients were further stratified analyzed by gender and age. Result: ①Etiological characteristics of patients with vertigo or dizziness：among the 3 137 patients with vertigo or dizziness in ENT department in our hosipital, the peripheral diseases of vestibular were the most common disease with a total of 1 607 cases, accounting for 51.23%. And there were 506 cases of the central diseases of vestibular accounting for 16.13%, 382 cases of other systemic diseases accounting for 12.18%, 85 cases（2.71%）of psychogenic vertigo, 557 cases （17.76%）of unknown etiology. ②Analysis of the frequent and serious causing of patients with vertigo or dizziness: among the 2 138(68.15%) patients with vertigo or dizziness, BPPV with a total of 827 cases (26.36%) was the most prevalent,while 215(25.99%) of them were diagnosed as self-cured BPPV,vestibular neuritis and VM were the second prevalent with 420 cases (13.39%) and 329 cases (10.49%) respectively, Meiniére disease, recurrent vestibular disease, sudden deafness with vertigo were the third prevalent with 209 cases (6.66%), 144 cases (4.59%), 102 cases (3.25%), respectively; well psychogenic vertigo and PCI were relatively rare, with respectively 85 cases (2.71%) and 22 cases (0.70%). Eotiology analysis stratified by age: The causes of vertigo or dizziness were ranged with age, and patients of 50-70 years old were most common with a total of 1 011 cases, accounting for 49.6%. Etiology analysis stratified by gender: There was gender difference in patients with vertigo or dizziness,such as BPPV, VM, recurrent vestibular disease, sudden deafness with vertigo and psychogenic vertigo were common in female, while PCI in male insteadly. Conclusion: ①Among the patients with vertigo or dizziness, the pheripheral diseases of vestibular are the most prevalent, in which BPPV takes the highest accidence. ②Patients ranging from 50 to 70 years old take the main parts in patients with vertigo or dizziness. And there is an obvious gender difference in patients with BPPV, VM, recurrent vestibular disease, sudden deafness with vertigo, psychogenic vertigo and PCI.

[Clinical features and advanced progress of secondary BPPV]

BPPV is a disease provoked by abrupt head movements, results in short paroxysmal vertigo or nystagmus. These patients often can accurately describe the dizziness happened when they head move suddenly, especially when looking upward, turning over in bed, lying down, or bending over. BPPV is divided into idiopathic BPPV and secondary BPPV, in most cases. The underlying cause cannot be determined, which is called idiopathic; however, in 30% patients, BPPV may be attributed to a specific cause and is termed secondary BPPV. We reviewed the pathogenesis, mechanisms, clinical features, treatment and the latest progress of secondary BPPV.

Our experience with 500 patients with benign paroxysmal positional vertigo: Reexploring aetiology and reevaluating MRI investigation

OBJECTIVE

To explore the aetiology of and to evaluate the importance of MRI investigation on the posterior semicircular canal benign paroxysmal positional vertigo in an Irish population.

METHODS

A retrospective observational study of 500 patients with posterior semicircular canal benign paroxysmal positional vertigo, diagnosed and treated by the senior author over a 10-year period. Most patients underwent an MRI brain and inner ear, following the same scan protocol. This included T1 weighted sagittal IR-FSPGR volume, axial T2 weighted, gradient echo T2 weighted and FLAIR sequences plus time of flight cerebral angiography.

RESULTS

The average age of presentation was 56 years; with the overall female to male ratio was 1.6:1, which was largely the net results of 2 age groups. Over 30% of our patients recalled distinct aetiological triggers, of which the top 3 were trauma, infection, and surgery. These accounted for 16%, 6%, and 5%, respectively. More than 25% of the patients were discovered to have abnormal intracranial findings on MRI. The 2 most common non-infarct incidental findings were neoplasia and vascular abnormalities. Although fewer than 20 patients had acute intracranial haemorrhage or malignant tumours, most of them were urgently referred to neurosurgeon due to the life-threatening nature of the condition. One round of particle repositioning manoeuver was successful in treating 84% of the patients, and the 2-year recurrence rate was only 2.2%.

CONCLUSION

The diagnosis of posterior semicircular canal benign paroxysmal positional vertigo is thought to be relatively easy to make, and the treatment is highly effective. Clinicians should be fully aware of and prepared for the diverse aetiology, and thus have no hesitation in requesting MRI scan as an important investigation.

[Analysis of 118 cases of benign paroxysmal positional vertigo after trauma]

Objective:The aim of this study is to retrospective analysis the clinic features of 118 cases of benign paroxysmal positional vertigo after trauma. Method:Analyzes clinic features of injury in 118 cases of benign paroxysmal positional vertigo after trauma, and classified and localized the craniocerebral trauma. The 118 cases were tested with different positioning tests in the sequence of Dix hallpike test and rolling test. Then, proper otolith manual reduction was given. Result:In 118 cases of BPPV after trauma including 35 cases of skull fracture, 6 cases of concussion, 17 cases of scalp hematoma, 28 cases of scalp laceration, 14 cases of mild brain contusion and 18 cases of head combined injury. The distributions of head injury were 57 at front temporal, 24 at top, 22 at occipital and 15 at maxillofacial region. The latency of BPPV after head injury varies from 1day to 1month. The incidence of 3-7 day after head injury was the highest, followed by 7-14 days, 0-3 days, and the lowest incidence rate of 14 day to 1 month. Canal type 118 BPPV patients after head injury accounting for up to 57.6% of the horizontal semicircular canal accounted for 33.1%, mixed 9.3%. Conclusion:The patients with front temporal trauma and skull fracture were prone to have BPPV. The peak incidence of BPPV was 3-14 days after head injury. The most common type of BPPV was PC BPPV, and the HC BPPV was the second type. A good curative effect can be manipulative reduction after trauma BPPV..

[Clinical analysis of benign paroxysmal positional vertigowith multiple canal involvement]

Objective:To compare the clinical features and outcomes between patients with multi-canal benign paroxysmal positional vertigo(BPPV) and single-canal BPPV.Method:Five-hundred and seventy-eight patients with BPPV were retrospectively analyzed and divided into three groups: single-canal BPPV(526 cases),multi-canal BPPV in unilateral ear(11 cases) and multi-canal BPPV in both ears(41 cases).All patients were diagnosed by using the Dix-Hallpike test or roll test and treated with the canalith repositioning procedure.The following factors,including aetiology,age,sex,response to treatment and recurrence,were compared among the three groups.Results:①Greater percentage of idiopathic cases were identified in single-canal(66.2%:48.2%,P<0.01).Traumatic origin and prior history of BPPV were more common in bilateral multi-canal(41.6%:9.2%,P<0.05)and unilateral multi-canal (36.2%:0,P<0.01)respectively.②The recurrence rate was higher in multi-canal BPPV(40.4%:14.3%,P<0.01).Conclusion:Idiopathic BPPV is more common in single-canal BPPV.Potential causes may be identified in multi-canal BPPV.However,over 90% of the patients with single-canal and multi-canal BPPV are cured.

Benign Paroxysmal Positional Vertigo after Dental Procedures: A Population-Based Case-Control Study

Background

Benign paroxysmal positional vertigo (BPPV), the most common type of vertigo in the general population, is thought to be caused by dislodgement of otoliths from otolithic organs into the semicircular canals. In most cases, however, the cause behind the otolith dislodgement is unknown. Dental procedures, one of the most common medical treatments, are considered to be a possible cause of BPPV, although this has yet to be proven. This study is the first nationwide population-based case-control study conducted to investigate the correlation between BPPV and dental manipulation.

Methods

Patients diagnosed with BPPV between January 1, 2007 and December 31, 2012 were recruited from the National Health Insurance Research Database in Taiwan. We further identified those who had undergone dental procedures within 1 month and within 3 months before the first diagnosis date of BPPV. We also identified the comorbidities of the patients with BPPV, including head trauma, osteoporosis, migraine, hypertension, diabetes, hyperlipidemia and stroke. These variables were then compared to those in age- and gender-matched controls.

Results

In total, 768 patients with BPPV and 1536 age- and gender-matched controls were recruited. In the BPPV group, 9.2% of the patients had undergone dental procedures within 1 month before the diagnosis of BPPV. In contrast, only 5.5% of the controls had undergone dental treatment within 1 month before the date at which they were identified (P = 0.001). After adjustments for demographic factors and comorbidities, recent exposure to dental procedures was positively associated with BPPV (adjusted odds ratio 1.77; 95% confidence interval 1.27–2.47). This association was still significant if we expanded the time period from 1 month to 3 months (adjusted odds ratio 1.77; 95% confidence interval 1.39–2.26).

Conclusions

Our results demonstrated a correlation between dental procedures and BPPV. The specialists who treat patients with BPPV should consider dental procedures to be a risk factor, and dentists should recognize BPPV as a possible complication of dental treatment.

Benign paroxysmal positional vertigo (BPPV): it may occur after dental implantology. A mini topical review

OBJECTIVE

Benign Paroxysmal Positional Vertigo (BPPV) is one of the most frequent vestibular disorders. BPPV as a complication of Osteotome Sinus Floor Elevation (OSFE) is a complication that rarely occurs. The aim of this paper is to better understand the mechanisms underlying the BPPV after SFE with the osteotomes. This could be important for all the dental and maxillofacial surgeons that should know and manage this clinical occurrence.

DISCUSSION

The osteotome sinus floor elevation (OSFE), firstly described by Summers requires the use of a surgical mallet for striking the bone, until the optimal depth is reached. The surgical mallet develops a mechanical trauma, even if the striking is performed with a gentle percussion. The recent literature describes an average occurrence of OSFE-induced BPPV quite low, but the symptoms show to be unpleasant and severe, often able to alter the patient's daily life.

CONCLUSIONS

A successful remission of BPPV following treatment with a particle repositioning maneuver will be necessary and relatively urgent for the surgeons who have experienced this clinical complication. The surgeons, therefore, must be aware of these complications and about the ways to manage them.

The relationship between benign paroxysmal positional vertigo and thyroid autoimmunity

CONCLUSION

Although there have been few studies concerning BPPV and thyroid autoimmunity and a positive relation was found between them, this study didn't find any relation between BPPV and thyroid autoimmunity. IT is thought that further large-scale studies must be done to clarify the relation.

OBJECTIVES

Benign paroxysmal positional vertigo (BPPV) consists of ∼ 20% of vestibular disorders. Self-limited rotatory nystagmus with positional vertigo are the main findings of BPPV. Although canalolithiasis theory was confirmed by demonstrating freely floating debris in the endolymph of the posterior semicircular channel in following studies, currently, the etiology hasn't been explained totally. This study investigated the relation of BPPV and thyroid autoimmunity evaluated via measurement of serum thyroid autoantibodies.

METHOD

Fifty patients (37 female, 13 male) with BPPV (BPPV group), 52 patients (40 female, 12 male) with non-BPPV vertigo (non-BPPV group) and 60 otherwise normal control (38 female, 22 male) samples were enrolled in the study. All samples of BPPV, non-BPPV groups and controls had undergone a cochleovestibular test following thorough ENT examination. After blood samples were drawn from each subject, thyroid-stimulating hormone (TSH), anti-thyroid peroxidase antibody (TPO-Ab) and anti-thyroglobulin antibody (TG-Ab) levels were measured accordingly.

RESULTS

In the study, eight patients of the BPPV group (16%) had a high thyroid antibody level. In the non-BPPV group, six patients (11.5%) had elevated thyroid antibodies. In the control group, 15 patients (25%) had elevated thyroid antibodies. TSH values of all subjects were detected to be within normal range. No statistical difference was found between the groups with respect to TG-Ab and TPO-Ab values (p-values = 0.729 and 0.812, respectively).

[Benign paroxysmal positional vertigo in children after head trauma]

We present an eight-year-old boy with benign paroxysmal positional vertigo (BPPV) after a head trauma, successfully treated with Epley's manoeuvre. BPPV is a common cause of vestibular vertigo in adults, but it is rarely seen in children. Diagnostic work-up is challenging as children often lack the ability to describe their symptoms accurately and to cooperate in clinical examination. The diagnosis should be suspected in children with a relevant medical history and verified by positional testing. BPPV of childhood is treated with otolith repositioning manoeuvres, and the prognosis is good.

Do viral infections have a role in benign paroxysmal positional vertigo?

OBJECTIVES

To investigate the role of viral infection in benign paroxysmal positional vertigo (BPPV).

METHODS

In this retrospective study, 483 patients with BPPV were included in the study group. The control group consisted of 461 healthy subjects. In both groups, serologic analysis of viral agents (HSV1, HSV2, Herpes zoster, EBV, CMV, adenovirus, influenza, and parainfluenza virus) was performed.

RESULTS

With the exception of influenza and parainfluenza, all viral serology values were higher in the BBPV group than the control group. We also observed seasonal variation. The BPPV group exhibited elevated values for HSV1 and adenovirus in March and May, for Herpes zoster, adenovirus, and influenza in April, for HSV1 in June, and for HSV1 and CMV in September, compared to the control group. In October, the BPPV group showed increased values for all of the viruses studied, compared to the control group.

CONCLUSION

BPPV is associated with positive viral serology, particularly during certain months of the year, mainly in spring and autumn. Viral infection might promote BPPV attacks due to the development of vestibulopathy or induce secondary BPPV via viral infection-related neurolabyrinthitis.