Benign Paroxysmal Positional Vertigo Group Research Articles

Do Patients with Benign Paroxysmal Positional Vertigo Have a Higher Prevalence of Osteoporosis? A Systematic Review and Meta-Analysis.

Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder characterized by episodic vertigo. BPPV primarily affects older adults. Thus, understanding the potential relationship between BPPV and osteoporosis is clinically important. We performed a systematic search of MEDLINE (PubMed), Embase, and Cochrane Library databases for studies on the risk of osteoporosis between BPPV (+) and BPPV (-) groups up until 17 April 2023. We compared osteoporosis prevalence between groups and performed subgroup analyses for male, female, and older patients (aged ≥ 55 years). The 12 studies included 32,460 patients with BPPV and 476,304 controls. Pooled analysis showed that the BPPV (+) group had a significantly higher osteoporosis risk than the control group (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.45-2.06; p < 0.01). Subgroup analyses also presented similar trends as male (OR, 2.41; 95% CI, 1.18-4.90; p = 0.02), female (OR, 2.14; 95% CI, 1.57-2.92; p < 0.001), and older patient subgroups (OR, 1.91; 95% CI, 1.47-2.49; p < 0.01) showed a higher osteoporosis risk in the BPPV (+) group than in the control group. This meta-analysis supports the hypothesis that patients with BPPV have a higher osteoporosis prevalence than those without.

The importance of Epley maneuver in posterior canal benign paroxysmal positional vertigo.

We investigated symptom scores and quality of life in unilateral posterior canal benign paroxysmal positional vertigo (BPPV) patients. In this retrospective and multicentric study, 78 patients with unilateral posterior canal BPPV (47 right-sided and 31 left-sided) were included. All patients have performed the Standard Epley maneuver. Features of the nystagmus [nystagmus duration (second), latent period (second)] and features of the disease [side (right or left-sided), disease duration (years), and recurrence of disease (present or absent)] were noted. Before and 1 week after the Epley maneuver, all patients were evaluated using the Vertigo Symptom Scale (VSS), Vertigo Dizziness Imbalance Symptom Scale (VDI-SS), and Vertigo Dizziness Imbalance health-related quality of life scale (VDI-HQoL). Our results showed that VSSs of the right-sided group were significantly higher than those in the left-sided group before and 1 week after the maneuver (p<0.05). One week after the maneuver, VDI-HQoLs of the left-sided group were significantly higher than those in the right-sided group (p<0.05). In all right-sided and left-sided groups, at 1 week after the maneuver, VSSs were significantly lower, and VDI-SSs and VDI-HQoLs were significantly higher than those before the maneuver (p<0.05). As VSS values increased, VDI-SS and VDI-HQoL values decreased (p<0.05). In the left-sided group, VSS values decreased, and VDI-HQoL values increased. As disease duration increased, VSS values increased before the maneuver (p<0.05). In females, VSS values increased, and VDI-SS and VDI-HQoL values decreased before the maneuver (p<0.05). In posterior canal BPPV, the Epley maneuver effectively decreased VSS values and increased VDI-SS and VDI-HQoL values. In the left-sided BPPV group, there were lower VSS values and higher VDI-HQoL values that showed better quality of life of the patients. Older age and female gender are other factors related to lower quality of life with higher symptom scores.

Turkish validity and reliability study of the benign paroxysmal positional vertigo diagnostic scale

Objectives: The study aimed to evaluate the Turkish validity and reliability of the benign paroxysmal positional vertigo (BPPV) diagnostic scale. Patients and Methods: One hundred seventeen patients (67 females, 50 males; mean age: 49.3±12.3 years; range 18 to 74 years) over the age of 18 who were diagnosed or suspected of BPPV, Meniere's disease, vestibular neuritis, or other peripheral vestibular disease were included. Participants filled out the BPPV diagnostic scale. The affected canal and the ear side were determined by performing positional maneuvers to confirm the diagnosis of BPPV. The final version of the scale was created by performing language and content validity, construct validity, reliability, and test-retest analyses of the BPPV diagnostic scale in the given order. Results: Of the 117 patients, 70 were diagnosed with BPPV, 26 with Meniere’s disease, 16 with vestibular neuritis, and five participants with other peripheral vestibular disease. Kendal W for content validity was 0.060 (p=0.700&gt;0.05), and expert opinions showed good agreement. The factor load of the BPPV diagnostic scale was found within the normal range (0.364 to 0.807). Goodness of fit index values were obtained above 0.90. According to this result, the model fit well. The internal consistency Cronbach's alpha (a) coefficient of the scale was 0.716. This value showed that the scale had good reliability. According to the results of the scale, a statistically significant difference was found between the responses of the BPPV group and the other diagnostic groups (p&lt;0.05). Conclusion: The Turkish version of the BPPV diagnostic scale was found to be valid and reliable. This scale is useful in detecting BPPV and establishing the differential diagnosis. The use of the scale is thought to be beneficial in patients with suspected BPPV but who have difficulties in diagnosis and to support objective tests.

Early treatment for benign paroxysmal positional vertigo secondary to sudden sensorineural hearing loss.

Sudden sensorineural hearing loss (SSNHL) accompanied by benign paroxysmal positional vertigo (BPPV) is relatively common in the clinic. There are unified standards for the treatment of primary BPPV with good reduction effect, while there are few studies on the treatment of BPPV secondary to SSNHL within 1 week of onset. The study was to investigate the treatment of BPPV secondary to SSNHL and compare its manual reduction with that of primary BPPV. We selected 90 patients with BPPV accompanied by SSNHL within a week of onset and 210 primary BPPV patients at Hebei Provincial Eye Hospital from June 2020 to December 2022. The former group was divided into the medicine group and manual reduction plus medicine group. The medicines used were extract of Ginkgo biloba leaves injection, betahistine hydrochloride injection and oral prednisone. We contrasted the efficacy respectively for posterior semicircular canal BPPV (psc-BPPV), horizontal semicircular canal BPPV (hsc-BPPV) and multiple semicircular canal BPPV (msc-BPPV). In addition, we compared the manual reduction effect for primary BPPV and manual reduction group, and the evaluation of efficacy are the intensity of nystagmus and the clinical symptoms. In the secondary BPPV group, there was no difference in efficacy between the medicine group and manual reduction group at the 7th-day after reduction for psc-BPPV, hsc-BPPV, and msc-BPPV (P > .05). The immediate effect of reduction was significantly different between the primary BPPV group and the group with SSNHL and BPPV for both psc-BPPV and hsc-BPPV (P < .05), and the effect of the primary BPPV group was better, but it was no difference for msc-BPPV (P > .05). For the treatment of BPPV accompanied by SSNHL within 1 week of onset, the additional reduction therapy showed no benefit, so we need to apply medication for SSNHL.

Clinical and Prognostic Implications of Cervical and Ocular Vestibular Evoked Myogenic Potentials (cVEMP and oVEMP) in Benign Paroxysmal Positional Vertigo (BPPV): A Prospective Study.

Several studies have investigated the efficacy of VEMP (vestibular evoked myogenic potential) in patients with vestibular disorders and BPPV (benign paroxysmal positional vertigo). However, previous data were inconclusive. The aim of this study was to investigate the difference in latency, amplitude P1-N1, asymmetry ratio (AR), and cervical/ocular-VEMP values between BPPV patients and healthy controls. 125 healthy subjects and 42 BPPV patients were prospectively enrolled in the study. In both groups, c/oVEMP tests with 500 Hz tone-burst stimuli were performed. Latencies P1, N1 peaks, and corrected amplitudes (CA) were measured, and AR was calculated. in the BPPV group, 14.29% of patients lacked oVEMPs that recovered after therapy. N1 latencies were significantly elongated, and 50% of patients had pathological AR; this value normalized at follow-up sessions. In addition, there was a reduction in CA in the pathologic ear compared to healthy ears (p = 0.04) and compared to healthy controls (p = 0.01). For cVEMP, a significant reduction in latency-P1 was observed in BPPV patients compared to controls; no significant differences were observed for P1, N1, and CA values between the two ears. The cVEMPs were absent in 14.29% of BPPV patients (AR > 35) that recovered after therapy. We identified several abnormal c/oVemp values in BPPV patients compared with healthy controls, with most changes in values occurring in oVEMPs, suggesting that utricular dysfunction may be more common than saccular. In addition, patients with oVEMP alteration showed later clinical recovery, suggesting a possible prognostic role of the test.

Otolin-1 as a biomarker for the evaluation of the effectiveness of betahistine treatment for benign paroxysmal positional vertigo

Objective Benign paroxysmal positional vertigo (BPPV) is the most common vertigo disorder. Betahistine is the most commonly used drug in the treatment of vertigo, however its effect on the inner ear is not fully known. Otolin-1 is an inner ear-specific glycoprotein that can be identified in peripheral blood. The aim of the study was to determine the effect of treatment of betahistine for BPPV on serum otolin-1 levels. Methods Thirty (30) patients with BPPV and 30 healthy controls were enrolled in the study. Serum otolin-1 levels were measured before and 14 days after perioral (po) betahistine treatment in the BPPV group, whereas otolin-1 level was examined once in controls. The efficacy of treatment was evaluated with Dizziness Handicap Index (DHI) and Visual Analog Scale (VAS) in the BPPV group. Results Otolin-1 levels were statistically significantly higher in patients with BPPV than controls. In the BPPV group, serum otolin-1 level was found to be statistically significantly lower after betahistine treatment. There was a statistically significantly difference between pre-treatment and posttreatment groups regarding to both DHI and VAS scores. Conclusion Serum otolin-1 can be used as a biomarker in monitoring the effectiveness of treatment of BPPV with betahistine as well as diagnosis of BPPV.

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

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. 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. 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. 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.

Investigating the Role of Oxidative Stress in Benign Paroxysmal Positional Vertigo with Spot Urine.

The objectives of this study were to evaluate the role of oxidative stress in benign paroxysmal positional vertigo (BPPV) by measuring urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG), 8-hydroxy-guanosine (8-OHG), and 8-hydroxy-guanine levels. Thirty-one adult female patients diagnosed with BPPV were included in this study. Patients with central pathologies and other peripheral causes of vertigo were excluded from the study. The patients were evaluated for oxidative stress during and after the BPPV attack with blood samples and spot urine tests. Depression, anxiety, and stress scale (DASS) questionnaire was used to evaluate emotional stress. A control group consisting of 30 age-matched healthy women was formed. Urinary oxidative stress values during the attack were significantly higher than the post-treatment group and the healthy control group (p<0.05). There was no significant difference between the urinary oxidative stress values of the BPPV group after treatment and the healthy control group (p>0.05). DASS scores were significantly higher during the attack and after the treatment compared to the healthy control group (p<0.05). The increase in spot urinary 8-OHdG, 8-OHG, and 8-hydroxy-guanine levels can be used as a biomarker for oxidative stress in patients with BPPV. Furthermore, emotional stress can also trigger BPPV attacks by increasing oxidative stress.

Investigation of the Relationship Between BPPV with Anxiety, Sleep Quality and Falls.

To investigate the effects of dizziness on sleep quality and psychological status in patients with benign paroxysmal positional vertigo (BPPV) and to evaluate its relationship with falls. A Demographic Data Form, a Visual Vertigo Analog Scale, the Falls Efficacy Scale - International (FES-I), the Hospital Anxiety and Depression Scale (HADS), and the Pittsburgh Sleep Quality Index (PSQI) were administered in 102 individuals diagnosed with BPPV by videonystagmography test. The same scales were applied to 75 healthy volunteers as the control group, and the two groups were compared. The BPPV group was divided into two groups as posterior canal and lateral canal BPPV. These two groups were compared among themselves and with the control group. A statistically significant difference was found between the BPPV and control groups, the lateral canal BPPV and posterior canal BPPV groups, the lateral canal BPPV and control groups, and the posterior canal BPPV and control groups in terms of total scores of the PSQI, the FES-I, and the HADS (p<0.001). In the regression model, the FES-I score was fully explained by the PSQI and HADS scores (p<0.001). BPPV significantly affects sleep quality, psychological state, and the risk of fall. The negative effects of BPPV restrict daily living activities, affect the prognosis of the disease, and increase the risk of falling. Considering that psychiatric issues and sleep problems increase the risk of falling in individuals with BPPV, counseling services on this issue would reduce the incidence of falls and related injuries.

Dynamic changes of otolith organ function before and after repositioning in patients with benign paroxysmal positional vertigo detected by virtual reality auxiliary technology: A cohort study.

To dynamically investigate otolith function in patients with benign paroxysmal positional vertigo (BPPV) before, after, and 1 month after repositioning, and explore the possible compensation mechanisms. Thirty-six patients confirmed with BPPV (canal lithiasis) treated in our hospital between August 2020 and March 2021, as well as 36 health controls matched for age and gender (normal control group, NC group) were enrolled. For NC group, the virtual reality (VR) auxiliary static subjective visual vertical (SVV), subjective visual horizontal (SVH), and SVV of dynamic unilateral centrifugation (DUC), were measured at inclusion. For the BPPV group, visual analog scale (VAS) was used to assess the vertigo degree, while static SVV, SVH, and DUC were performed before, after, and 1 month after repositioning. First, we compare the deviations of SVV0/SVH0° when the subject's head is in the positive position, and SVV of DUC between BPPV and NC groups before repositioning, after which we compared the deviations in SVV45, SVV90, SVH45, SVH90°, and SVV of DUC between the affected and unaffected sides before repositioning. Finally, paired t-test was used to compare the VAS score, deviations in static SVV0, SVV45, SVV90, SVH0, SVH45, and SVH90°, and deviations in SVV of DUC before, after, and 1 month after repositioning. (Here, 0, 45, and 90° refer to the angle which the center axis of head deviates from the gravity line.). SVV0 SVH0°, and SVV of DUC at 120 and 180°/s 0 significantly differed between BPPV and NC group before repositioning. The deviations in SVV45, SVV90, SVH45, SVH90°, and SVV of DUC at 120°/s-2 and 180°/s-4.5 did not significantly differ between bilateral sides in BPPV patients before repositioning. The deviation in SVH90° was significantly lower after repositioning than before. The deviation in SVH45° was significantly higher 1 month after repositioning than before. The deviation angle of SVV of DUC at 180°/s-0 was significantly lower after repositioning than before. The vertigo VAS score of patient with BPPV continued to decrease after repositioning. Before repositioning, the otolithic organ function of BPPV patients was obviously impaired, with no significant difference between the healthy and affected ear. After repositioning, there was a transient recovery of otolithic organ dysfunction followed by a sustained decline to similar levels to before repositioning.

[An analyzation on the characterization of frequency tuning of vestibular evoked myogenic potential in patients with unilateral vestibular hypofunction].

Objective: To explore the value of adding 1 kHz cervical vestibular evoked myogenic potential（cVEMP） and ocular vestibular evoked myogenic potential（oVEMP） in the auxiliary diagnosis of unilateral vestibular hypofunction. Methods:A retrospective analysis of 84 patients with unilateral vestibular hypofunction receiving two or more vestibular function tests was conducted,29 cases of unilateral Ménière's disease, 27 cases of benign paroxysmal positional vertigo （BPPV）, 8 cases of idiopathic sudden sensorineural hearing loss （ISSHL） with vertigo, and 20 cases of ISSHL without vertigo were included. SPSS 25.0 software was used for statistical analysis to observe the difference of frequency amplitude ratio （FAR） at 500 Hz/1 kHz of cVEMP and oVEMP between the experimental and control groups. Results:①The cVEMP elicitation rates were 95.24% （80/84） and 98.81% （83/84） for 500 Hz and 1 kHz, respectively; and the oVEMP elicitation rates were 78.57% （66/84） and 91.67% （77/84） for 500 Hz and 1 kHz, respectively. ②Except for the lateral difference of FAR in oVEMP of the posterior semicircular canal BPPV group and cVEMP of the horizontal semicircular canal BPPV group （P<0.05）, no significant lateral difference was observed in the other disease groups （P>0.05）. Conclusion:In patients with unilateral vestibular hypofunction, cVEMP and oVEMP showed different frequency tuning changes in different semicircular canal BPPV groups. Additionally, 1 kHz cVEMP and oVEMP as regular stimulation frequencies in clinical test, which has certain clinical reference significance for determining the diagnosis and prognosis of BPPV on the weak ear and in different semicircular canal involvement.

The Relationship Between Serum 25-hydroxyvitamin D and Calcium Levels and Idiopathic Benign Paroxysmal Positional Vertigo

Aim: We aimed to compare 25-hydroxy vitamin D (25-OH vitamin D) and Ca2+ levels of patients admitted to our clinic with the complaint of dizziness and diagnosed with idiopathic benign paroxysmal positional vertigo (BPPV) with those of healthy control group without dizziness and investigate the role of Ca2+ and 25-OH vitamin D in the development of BPPV.Material and methods: This study is a retrospective case-control study. The study sample consisted of 409 patients admitted to Alanya Training and Research Hospital Neurology outpatient clinic and diagnosed with idiopathic BPPV between 01.01.2018 and 01.08.2021, and of 338 control patients without any physician consultation due to vertigo, dizziness or imbalance in the last 1 year before admission to our clinic and whose serum vitamin D levels were measured, the Chi-square and T-test were utilized for statistical analysis.Results: Mean blood 25-OH vitamin D levels were 15.74 ng/mL and 17.91 ng/mL in BPPV and control groups, respectively. Serum 25-OH vitamin D levels were significantly lower in BPPV group than control group (p=0.01, p&amp;lt;0.05). Mean serum Ca2+ levels did not exhibit any difference in BPPV and control groups.Conclusion: Decreased serum levels of 25-OH vitamin D have been associated with the occurrence of BPPV independently of other key markers.

The Relationship Between Benign Paroxysmal Positional Vertigo and Vitamin D.

IntroductionBenign paroxysmal positional vertigo (BPPV) is a type of vertigo and its signs are short-time, severe attacks that occur in certain head and body positions. Recent studies have revealed that vitamin D deficiency correlates with BPPV and this is explained by cupulolithiasis and canalithiasis theories.MethodIn the present study, levels of serum vitamin D in the patients who were diagnosed as BPPV and those in the control group consisting of healthy individuals were investigated. In addition, it was examined whether vitamin D is influential on the rates of BPPV types. In our study, 258 patients who were diagnosed with BPPV after detailed ear-nose-throat and neurology examinations were examined. We compared the control group according to their ages, genders, and levels of vitamin D. In addition, we divided the BPPV group into two sub-groups according to their vitamin D levels (20-30 ng/ml and 20 g/ml lower), and each was compared by calculating vertigo types and ratios.ResultsThe BPPV group included 187 females and 71 males, and their mean age was 43.70 ± 15.44. The control group consisted of 65 females and 35 males, and the mean age of this group was 44.63 ± 15.42. The mean vitamin D levels of the females and males were 18.42 ± 5.07 and 19.82 ± 5.11, respectively, in this study. On the other hand, the mean vitamin D levels of healthy females and males were found to be 30.88 ± 10.74.ConclusionOur study found that the vitamin D levels of the individuals in the BPPV group were statistically significantly lower than those of the individuals who were in the control group. However, it was observed that vitamin D did not affect the rate of vertigo subtypes.

Comparison of calcium levels in patients with benign paroxysmal positional vertigo and the other type of vertigo

Introduction: Benign paroxysmal positional vertigo (BPPV) is commonly found in older women; caused by the presence of otoconia in semicircular canals, which will stimulate the ampulla. Degeneration of otoconia and abnormal calcium metabolism could contribute to BPPV. This study aims to find a difference in serum calcium levels between idiopathic BPPV and non-BPPV vertigo patients. Methods: Cross-sectional study was held in Wahidin Sudirohusodo hospital in Makassar from August to October 2019. Subjects who fulfilled the criteria were divided into two groups (BPPV and non-BPPV). Venous blood was taken to obtain serum calcium levels. Statistical analysis was performed with SPSS software version 21. Chi-square and Mann-Whitney tests were used to determine the relationship between variables. Result: As many as 45 subjects were grouped into BPPV (n=30) and non-BPPV (n=15). Majority of subjects were female (n=30). Mean serum calcium level was significantly lower in BPPV group (8.51±0.67 vs 8.9±0.63; p=0.023). Area under curve of serum calcium level according to vertigo type was 22.4% (p&lt;0.05). Optimal cut-off point for serum calcium level was 8.55 (p=0.024). Discussion: Majority of subjects in this study were females between 40-60 years old. Patients with BPPV tend to have lower serum calcium levels. Possible underlying me-chanisms include estrogen deficiency, otoconial degeneration, vitamin D deficiency, lack of sunlight, and abnormal calcium me-tabolism. Examination of serum calcium level and calcium supplementation could be considered for these patients. Some factors that affect serum calcium level were not considered in this study. It was concluded that examination of serum calcium level and calcium supplementation could be considered for patients with BPPV.

Differences of Sleep Disorders Between Vestibular Migraine and Benign Paroxysmal Positional Vertigo.

Introduction: Sleep disorders can affect the overall health and quality of life of patients. This study was conducted to compare the differences of sleep disorders in vestibular migraine (VM) patients and benign paroxysmal positional vertigo (BPPV) patients.Methods: VM patients, BPPV patients, and healthy controls (HCs) were recruited. Pittsburgh sleep quality index and polysomnography monitoring were used as subjective and objective, respectively, evaluation methods to evaluate the sleep quality of participants in the latest month.Results: Fifty-seven BPPV patients, 48 VM patients, and 42 HCs were included in this study. There were 79.16% VM patients, 54.39% BPPV patients, and 14.28% HCs with sleep disorders. The difference in the incidence rate of sleep disorders was significant between VM patients and BPPV patients (p = 0.008) and significantly higher in both the VM group (p < 0.00001) and BPPV group (p = 0.00004) than in the HC groups (14.28%). Compared with BPPV patients, the VM patients had the significantly lower sleep efficiency (p < 0.001) and N3 (p < 0.001) and the significantly higher time of wake-up after sleep onset (p < 0.001), N1 (p < 0.001), and N2 (p < 0.001). Meanwhile, the VM patients had significantly higher incidence rates of severe obstructive sleep apnea hypoventilation syndrome (p = 0.001) and periodic leg movement in sleep (p = 0.016).Conclusion: The incidence rate of sleep disorders was significantly higher in both VM and BPPV patients than in the HC groups. To improve the curative effects, clinicians should pay more attention to the comorbidity of sleep disorders in treating VM and BPPV.

Which Is More Important for the Prognosis of Sudden Sensorineural Hearing Loss with Vertigo, Canal Paresis or Benign Paroxysmal Positional Vertigo?

Objectives: This study was performed to determine characteristics and the prognostic values in idiopathic sudden sensorineural hearing loss (SSNHL) with comorbid ipsilateral canal paresis (CP) and/or benign paroxysmal positional vertigo (BPPV). Methods: Of the 338 patients with a diagnosis of idiopathic SSNHL, 29 patients (8.6%) with CP and 24 patients (7.1%) with BPPV were recruited and compared to 23 patients with SSNHL and vertigo but without CP or BPPV. The patients were evaluated for their initial hearing threshold, type of canal involved, response to repositioning maneuvers, and hearing outcome for 6 months. Results: Patients with CP (+) BPPV (‒) showed lower pure-tone averages than those with CP (‒) BPPV (+) on initial and follow-up audiograms. The improvement in pure-tone averages was less in the CP (+) BPPV (‒) group than in the CP (‒) BPPV (+) group. The improvement in speech discrimination scores was less in the CP (+) BPPV (‒) group than in the CP (‒) BPPV (‒) group. BPPV most commonly involved the posterior canal (15 of 24, 62.5%), followed by the horizontal canal (13 of 24, 54.2%). Three of 24 patients (12.5%) had recurrences of BPPV. Conclusions: CP is a more serious sign for hearing recovery than BPPV, although both CP and BPPV are negative prognostic indicators of auditory function in SSNHL. Concurrent CP and/or BPPV in SSNHL suggest combined damage to the vestibule and may indicate severe and widespread labyrinthine damage, leading to a poor prognosis.

The Association Between Serum Vitamin D Levels and Benign Paroxysmal Positional Vertigo.

This study aimed to evaluate the association between serum vitamin D levels and benign paroxysmal positional vertigo (BPPV). This prospective study consisted of 137 participants. There were 69 participants in the BPPV group compared with 68 healthy participants. Blood samples from both groups were collected from all participants to assess serum vitamin D levels. No significant difference in demographic data between BPPV and control groups. The results showed that the mean serum vitamin D levels in the BPPV group was lower than that of the control group (P value = .001). Among BPPV participants, there was no statistically significant difference between mean serum vitamin D levels of participants with recurrent BPPV, and that of newly diagnosed BPPV participants (P value = .313). A statistically significant association between lower mean serum vitamin D levels in the BPPV group compared with that of the control group. Therefore, low serum vitamin D levels may be one of the risk factors for BPPV.

Dizziness Handicap Inventory in Clinical Evaluation of Dizzy Patients.

(1) Objectives: The evaluation of dizzy patients is difficult due to nonspecific symptoms that require a multi-specialist approach. The Dizziness Handicap Inventory (DHI) is widely used in the assessment of dizziness-related disability, but its clinical efficacy needs further expansion. The aim of this study was to identify the subscales of DHI that may correlate with some vestibular or nonvestibular dysfunctions. (2) Material and methods: This observational study included 343 dizzy patients with one of the following clinical conditions: Vestibular impairment noncompensated or compensated, central or bilateral, benign paroxysmal positional vertigo (BPPV), migraine and psychogenic dizziness. Principal component analysis was used to examine the factorial structure of the questionnaire. (3) Results: The DHI questionnaire total scoring and its vestibular subscale distinguished between patients with compensated and uncompensated vestibular dysfunction with positive predictive values of 76% and 79%, respectively. The DHI items composing the F3 (positional) subscale revealed the highest scoring in the BPPV group with 75% sensitivity and 92% negative predictive value (NPV) in reference to Dix–Hallpike tests. The DHI total score and the subscales scores correlated with anxiety-depression, and the highest correlation coefficients were calculated for vestibular (F2 0.56) and anxiety (F5 0.51) subscales. (4) Conclusions: Our analysis revealed that the DHI vestibular subscale distinguishes between patients with compensated and uncompensated vestibular dysfunction. The positional subscale showed the highest scoring in the BPPV group with high sensitivity and low specificity of the test. The DHI is highly correlated with patients’ psychological status.

Analyses of the Relation between BPPV and Thyroid Diseases: A Nested Case-Control Study.

Background: This study investigated relationship between multiple thyroid disorders and benign paroxysmal positional vertigo (BPPV), adjusting for levothyroxine medication. Methods: The Korean National Health Insurance Service-Health Screening Cohort data from 2002 to 2015 were used. A total of 19,071 patients with BPPV were matched with 76,284 participants of a control group in a ratio of 1:4 for age, sex, income, and region of residence. The previous histories of thyroid disorders such as goiter, hypothyroidism, thyroiditis, hyperthyroidism, and autoimmune thyroiditis were investigated in both the BPPV and control groups. The odds ratios (ORs) for BPPV in thyroid diseases were calculated using conditional logistic regression analyses. Results: The histories of goiter (5.5% vs. 4.1%), hypothyroidism (4.7% vs. 3.7%), thyroiditis (2.1% vs. 1.6%), and hyperthyroidism (3.1% vs. 2.5%) were higher in the BPPV group than in the control group (all p < 0.001). Goiter, hypothyroidism, thyroiditis, and hyperthyroidism were associated with BPPV (adjusted OR = 1.28 (95% CI = 1.17–1.39) for goiter, 1.23 (95% CI = 1.10–1.37) for hypothyroidism, 1.13 (95% CI = 1.02–1.26) for hyperthyroidism, each p < 0.05). Conclusions: BPPV was associated with thyroid disorders such as goiter, hypothyroidism, thyroiditis, and hyperthyroidism.

Investigation of Serum Calcium and 25-Hydroxy Vitamin D Levels in Benign Paroxysmal Positional Vertigo Patients.

Benign paroxysmal positional vertigo (BPPV) is characterized by recurrent attacks of vertigo caused by head movements. It occurs as a result of otoconia falling into the semicircular canal. Calcium and 25 hydroxyvitamin D [25(OH)D] metabolism in the inner ear play an important role in otoconia formation and degeneration. Our aim in this study was to investigate the relationship between 25(OH)D levels and BPPV. This retrospective, case-controlled study included 52 patients with posterior canal BPPV and 52 controls aged 18 to 80 years. Age, sex, serum calcium, corrected calcium, and 25(OH)D levels of the BPPV and control group were compared. Twenty-three of the patients were male (44.2%) and 29 were female (55.8%). The average age was 55.6 years. The 25(OH)D level was 15.3 ng/mL in the BPPV group and 20.2 ng/mL in controls. There was no significant difference in 25(OH)D and albumin-corrected calcium values (P = .394; P = .084, respectively). In 80.7% of the BPPV group and 61.5% of the controls, 25(OH)D levels were 20 ng/mL and below. 25 hydroxyvitamin D deficiency was found statistically significantly more frequently in patients with BPPV (P = .030). In our study, serum 25(OH)D levels were found to be lower in patients with BPPV, and the rate of vitamin D deficiency was higher in these patients. Based on these results, it is recommended to examine the 25(OH)D levels of patients with BPPV at the time of diagnosis.