August 17, 2017

Vitamin D Deficiency Associated with BPPV Occurrence and Recurrence

There is increasing evidence that Vitamin D deficiency may be a risk factor for BPPV as well as its recurrences. BPPV is a condition whereby a person may suffer from brief but severe vertiginous attacks with head position changes that occur due to displaced otoliths (calcium crystals) within the inner ear.

Although easy to treat with precisely defined head position maneuvers (, i.e. Epley maneuver for posterior canal BPPV), its occurrence let alone recurrence can be alarming for patients. Although viral infections as well as head trauma are known risk factors for BPPV, these afflictions are not something a patient has any voluntary control over. However, vitamin D deficiency has also emerged as another potential risk factor for BPPV and IS something that a patient may have some control over.

Only in the past few years, increasing number of research has been published showing that:

• Osteoporosis is associated with increased risk of BPPV. [link]
• There appears to be an association between BPPV and decreased serum vitamin D. [link]
• During months when Vitamin D levels are historically low (May), BPPV occurs/recurs more frequently whereas during months where Vitamin D levels are historically high (Sept), BPPV occurs/recurs less frequently. [link]
• Improvement of serum 25-hydroxyvitamin D3 levels with vitamin D supplementation is associated with substantial decrease in BPPV recurrences. [link]

The theory that explains Vitamin D's relationship to BPPV goes something like this... The matrix found within bone and otoconia are similar. Calcium is the main component of otoconia and Vitamin D is required for calcium regulation. Therefore, a correlation between Vitamin D and BPPV is theoretically possible by its effect on calcium.

SO... at least for an individual who has suffered from BPPV with osteoporosis and certainly for those who suffer from BPPV recurrences, it may be worthwhile to take Vitamin D supplementation especially if serum levels are low.

Benign paroxysmal positional vertigo in older women may be related to osteoporosis and osteopenia. Ann Otol Rhinol Laryngol. 2003 Oct;112(10):885-9. 

The Association Between Serum Vitamin D Levels and Benign Paroxysmal Positional Vertigo. ENT Journal. April 2021. doi:10.1177/01455613211008561 

Osteoporosis as a risk factor for the recurrence of benign paroxysmal positional vertigo. Laryngoscope. 2013 Nov;123(11):2813-6. doi: 10.1002/lary.24099. Epub 2013 Apr 8.

Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo. J Neurol. 2013 Mar;260(3):832-8. doi: 10.1007/s00415-012-6712-2. Epub 2012 Oct 25.

Reduction of recurrence rate of benign paroxysmal positional vertigo by treatment of severe vitamin D deficiency. Auris Nasus Larynx. 2016 Jun;43(3):237-41. doi: 10.1016/j.anl.2015.08.009. Epub 2015 Sep 16.

The Seasonal Variation of Benign Paroxysmal Positional Vertigo. Otol Neurotol. 2017 Aug 8. doi: 10.1097/MAO.0000000000001534. [Epub ahead of print]

Osteoporosis increases the risk of benign paroxysmal positional vertigo: a nested case-control study using a national sample cohort. Eur Arch Otorhinolaryngol. 2019 Feb;276(2):335-342. doi: 10.1007/s00405-018-5230-y. Epub 2018 Dec 3.

Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.

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