Skip to main content

Advertisement

SpringerLink
Log in

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

  • Review
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Research Background

Vitamin D insufficiency/deficiency is known to be related to occurrences and recurrences of benign paroxysmal positional vertigo (BPPV). However, the efficacy of vitamin D supplementation in reducing recurrences of BPPV remains to be established. We performed a meta-analysis to determine the therapeutic effects of vitamin D supplementation, with or without calcium, for preventing recurrences of BPPV.

Methods

We searched the PubMed, the Embase, the Web of Science and the reference lists of the articles. We included randomized or non-randomized trials that determined the efficacy of supplementing vitamin D or related compounds, alone or with calcium, in comparison to placebo or no intervention in preventing recurrences of BPPV. The primary outcome was the number of patients with BPPV recurrences. Data were collected and pooled using a weighted relative risk (RR) with corresponding 95% CIs, where possible, by adopting the fixed-effect or random-effect model according to the heterogeneity among the studies. The between-study heterogeneity was tested using the χ2 test and the I2 statistic, and funnel plots were used to evaluate any publication bias.

Results

We included five trials (four non-randomized trials and one randomized controlled trial) with a total of 1250 participants. The analyses showed a significant preventive effect on the recurrences of BPPV (RR = 0.37; 95% CI = 0.18–0.76; p = 0.007 with the random-effects model) with supplementation of vitamin D. Although a considerable heterogeneity was detected among the studies, the sensitivity analyses showed the reliability and stability of our results.

Conclusions

Vitamin D supplementation provides a benefit for secondary prevention of BPPV. Supplementation of vitamin D should be considered in patients with frequent attacks of BPPV, especially when serum vitamin D is subnormal.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

References

  1. Kim HJ LJ, Choi JY, Kim JS Etiologic distribution of dizziness and vertigo in a referral-based dizziness clinic in South Korea. J Neurol (in press). doi:10.1007/s00415–020–09831–2

  2. Kim JS, Zee DS (2014) Clinical practice. Benign paroxysmal positional vertigo. N Engl J Med 370(12):1138–1147. https://doi.org/10.1056/NEJMcp1309481

    Article  CAS  PubMed  Google Scholar 

  3. Jeong SH, Kim JS, Shin JW, Kim S, Lee H, Lee AY, Kim JM, Jo H, Song J, Ghim Y (2013) Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo. J Neurol 260(3):832–838. https://doi.org/10.1007/s00415-00012-06712-00412(Epub 02012 Oct 00425)

    Article  CAS  PubMed  Google Scholar 

  4. Buki B, Ecker M, Junger H, Lundberg YW (2013) Vitamin D deficiency and benign paroxysmal positioning vertigo. Med Hypotheses 80(2):201–204. https://doi.org/10.1016/j.mehy.2012.1011.1029(Epub 2012 Dec 1014)

    Article  PubMed  Google Scholar 

  5. Talaat HS, Abuhadied G, Talaat AS, Abdelaal MS (2015) Low bone mineral density and vitamin D deficiency in patients with benign positional paroxysmal vertigo. Eur Arch Otorhinolaryngol 272(9):2249–2253. https://doi.org/10.1007/s00405-014-3175-3

    Article  PubMed  Google Scholar 

  6. Rhim GI (2016) Serum vitamin D and recurrent benign paroxysmal positional vertigo. Laryngoscope Investig Otolaryngol 1(6):150–153. https://doi.org/10.1002/lio1002.1035(eCollection 2016 Dec)

    Article  PubMed  PubMed Central  Google Scholar 

  7. Wu Y, Fan Z, Jin H, Guan Q, Zhou M, Lu X, Li L, Yan W, Gu C, Chen C, Han W (2018) Assessment of bone metabolism in male patients with benign paroxysmal positional vertigo. Front Neurol 9:742. https://doi.org/10.3389/fneur.2018.00742(eCollection 02018)

    Article  PubMed  PubMed Central  Google Scholar 

  8. Yang CJ, Kim Y, Lee HS, Park HJ (2018) Bone mineral density and serum 25-hydroxyvitamin D in patients with idiopathic benign paroxysmal positional vertigo. J Vestib Res 27(5–6):287–294. https://doi.org/10.3233/VES-170625

    Article  PubMed  Google Scholar 

  9. Han W, Fan Z, Zhou M, Guo X, Yan W, Lu X, Li L, Gu C, Chen C, Wu Y (2018) Low 25-hydroxyvitamin D levels in postmenopausal female patients with benign paroxysmal positional vertigo. Acta Otolaryngol 138(5):443–446. https://doi.org/10.1080/00016489.00012017.01416168(Epub 00012017 Dec 00016422)

    Article  CAS  PubMed  Google Scholar 

  10. Ding J, Liu L, Kong WK, Chen XB, Liu X (2019) Serum levels of 25-hydroxy vitamin D correlate with idiopathic benign paroxysmal positional vertigo. Biosci Rep 39(4): BSR20190142. https://doi.org/10.1042/BSR20190142

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Lips P (2006) Vitamin D physiology. Prog Biophys Mol Biol 92(1):4–8. https://doi.org/10.1016/j.pbiomolbio.2006.02.016

    Article  CAS  PubMed  Google Scholar 

  12. Sheikhzadeh M, Lotfi Y, Mousavi A, Heidari B, Bakhshi E (2016) The effect of serum vitamin D normalization in preventing recurrences of benign paroxysmal positional vertigo: a case-control study. Caspian J Intern Med 7(3):173–177

    PubMed  PubMed Central  Google Scholar 

  13. Talaat HS, Kabel AMH, Khaliel LH, Abuhadied G, El-Naga HAERA, Talaat AS (2016) Reduction of recurrence rate of benign paroxysmal positional vertigo by treatment of severe vitamin D deficiency. Auris Nasus Larynx 43(3):237–241. https://doi.org/10.1016/j.anl.2015.08.009

    Article  PubMed  Google Scholar 

  14. Kahraman SS, Ozcan O, Arli C, Ustun I, Erduran R, Akoglu E, Gokce C (2016) Calcium homeostasis during attack and remission in patients with idiopathic benign paroxysmal positional vertigo. Otol Neurotol 37(9):1388–1392. https://doi.org/10.1097/MAO.0000000000001167

    Article  PubMed  Google Scholar 

  15. Gülşah Çıkrıkçı Işık YÇ, Emektar E, Çorbacıoğlu ŞK (2017) Analysis of vitamin D and calcium levels in benign paroxysmal positional vertigo. Eur J Emerg Med. https://doi.org/10.5152/eajem.2017.58077

    Article  Google Scholar 

  16. Karataş A, Acar Yüceant G, Yüce T, Hacı C, Cebi IT, Salviz M (2017) Association of benign paroxysmal positional vertigo with osteoporosis and vitamin D deficiency: a case controlled study. J Int Adv Otol 13(2):259–265. https://doi.org/10.5152/iao.2016.2640

    Article  PubMed  Google Scholar 

  17. Maslovara S, Butkovic Soldo S, Sestak A, Milinkovic K, Rogic-Namacinski J, Soldo A (2018) 25 (OH) D3 levels, incidence and recurrence of different clinical forms of benign paroxysmal positional vertigo. Braz J Otorhinolaryngol 84(4):453–459. https://doi.org/10.1016/j.bjorl.2017.1005.1007(Epub 2017 Jun 1011)

    Article  PubMed  Google Scholar 

  18. Carneiro de Sousa PJM, Abreu Pereira DM, Pereira CM, de Magalhães P, Duarte DRS, da Silva T, Cunha NM (2019) Vitamin D deficiency and benign paroxysmal positioning vertigo. Hearing Balance Commun 17(2):179–181. https://doi.org/10.1080/21695717.2019.1590988

    Article  Google Scholar 

  19. Rhim GI (2019) Serum Vitamin D and Long-term Outcomes of Benign Paroxysmal Positional Vertigo. Clin Exp Otorhinolaryngol 12(3):273–278. https://doi.org/10.21053/ceo.22018.00381Epub 22019 Mar 21051

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Jeong SH, Kim JS, Kim HJ, Choi JY, Koo JW, Choi KD, Park JY, Lee SH, Choi SY, Oh SY, Yang TH, Park JH, Jung I, Ahn S, Kim S (2020) Prevention of benign paroxysmal positional vertigo with Vit D supplementation: a randomized trial. Neurology (in press)

  21. Kim SY, Park JE, Lee YJ, Seo HJ, Sheen SS, Hahn S, Jang BH, Son HJ (2013) Testing a tool for assessing the risk of bias for nonrandomized studies showed moderate reliability and promising validity. J Clin Epidemiol 66(4):408–414. https://doi.org/10.1016/j.jclinepi.2012.09.016

    Article  PubMed  Google Scholar 

  22. Califano L, Salafia F, Melillo MG, Mazzone S. (2019) Is hypovitaminosis D a risk factor for either the onset or the recurrence of Benign Paroxysmal Positional Vertigo? Frontiera ORL. http://www.frontieraorl.it/en/is-hypovitaminosis-d-risk-factor-for-either-the-onset-or-the-recurrence-of-benign-paroxysmal-positional-vertigo/

  23. Lim DJ (1980) Morphogenesis and malformation of otoconia: a review. Birth Defects Orig Artic Ser 16(4):111–146

    CAS  PubMed  Google Scholar 

  24. Welling DB, Parnes LS, O'Brien B, Bakaletz LO, Brackmann DE, Hinojosa R (1997) Particulate matter in the posterior semicircular canal. Laryngoscope 107(1):90–94. https://doi.org/10.1097/00005537-199701000-00018

    Article  CAS  PubMed  Google Scholar 

  25. Lim DJ (1984) Otoconia in health and disease. A review. Ann Otol Rhinol Laryngol Suppl 112:17–24. https://doi.org/10.1177/00034894840930s404

    Article  CAS  PubMed  Google Scholar 

  26. Tusa RJ (2001) Benign paroxysmal positional vertigo. Curr Neurol Neurosci Rep 1(5):478–485. https://doi.org/10.1007/s11910-001-0110-y

    Article  CAS  PubMed  Google Scholar 

  27. House MG, Honrubia V (2003) Theoretical models for the mechanisms of benign paroxysmal positional vertigo. Audiol Neurootol 8(2):91–99. https://doi.org/10.1159/000068998

    Article  PubMed  Google Scholar 

  28. Hughes I, Thalmann I, Thalmann R, Ornitz DM (2006) Mixing model systems: using zebrafish and mouse inner ear mutants and other organ systems to unravel the mystery of otoconial development. Brain Res 1091(1):58–74. https://doi.org/10.1016/j.brainres.2006.01.074

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Mechigian I, Preston RE, Johnsson LG, Schacht J (1979) Incorporation of radioactive calcium into otolithic membranes of the guinea pig after aminoglycoside treatment. Acta Otolaryngol 88(1–2):56–60. https://doi.org/10.3109/00016487909137140

    Article  CAS  PubMed  Google Scholar 

  30. Zhang DM, Takumida M, Harada Y (1996) Incorporation of tetracycline into otoconia of the guinea-pig following streptomycin intoxication. Acta Otolaryngol 116(6):812–816. https://doi.org/10.3109/00016489609137931

    Article  CAS  PubMed  Google Scholar 

  31. Zhang DM, Takumida M, Harada Y (1996) Uptake of tetracycline in otoconia of the guinea pig. Acta Otolaryngol 116(5):732–736. https://doi.org/10.3109/00016489609137915

    Article  CAS  PubMed  Google Scholar 

  32. Marquis RE, Hudspeth AJ (1997) Effects of extracellular Ca2+ concentration on hair-bundle stiffness and gating-spring integrity in hair cells. Proc Natl Acad Sci USA 94(22):11923–11928. https://doi.org/10.1073/pnas.94.22.11923

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Yamauchi D, Raveendran NN, Pondugula SR, Kampalli SB, Sanneman JD, Harbidge DG, Marcus DC (2005) Vitamin D upregulates expression of ECaC1 mRNA in semicircular canal. Biochem Biophys Res Commun 331(4):1353–1357. https://doi.org/10.1016/j.bbrc.2005.04.053

    Article  CAS  PubMed  Google Scholar 

  34. Lins U, Farina M, Kurc M, Riordan G, Thalmann R, Thalmann I, Kachar B (2000) The otoconia of the guinea pig utricle: internal structure, surface exposure, and interactions with the filament matrix. J Struct Biol 131(1):67–78. https://doi.org/10.1006/jsbi.2000.4260

    Article  CAS  PubMed  Google Scholar 

  35. Davis JG, Burns FR, Navaratnam D, Lee AM, Ichimiya S, Oberholtzer JC, Greene MI (1997) Identification of a structural constituent and one possible site of postembryonic formation of a teleost otolithic membrane. Proc Natl Acad Sci U S A 94(2):707–712. https://doi.org/10.1073/pnas.94.2.707

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Murayama E, Takagi Y, Ohira T, Davis JG, Greene MI, Nagasawa H (2002) Fish otolith contains a unique structural protein, otolin-1. Eur J Biochem 269(2):688–696. https://doi.org/10.1046/j.0014-2956.2001.02701.x

    Article  CAS  PubMed  Google Scholar 

  37. Parham K, Sacks D, Bixby C, Fall P (2014) Inner ear protein as a biomarker in circulation? Otolaryngol Head Neck Surg 151(6):1038–1040. https://doi.org/10.1177/0194599814551127

    Article  PubMed  Google Scholar 

  38. Sacks D, Parham K (2015) Preliminary report on the investigation of the association between BPPV and osteoporosis using biomarkers. Otol Neurotol 36(9):1532–1536. https://doi.org/10.1097/MAO.0000000000000853

    Article  PubMed  Google Scholar 

  39. Parham K, Kuchel GA, McElhaney JE, Haynes L (2018) A relationship between blood levels of Otolin-1 and vitamin D. Otol Neurotol 39(4):e269–e273. https://doi.org/10.1097/MAO.0000000000001747

    Article  PubMed  PubMed Central  Google Scholar 

  40. Dusso AS, Brown AJ, Slatopolsky E (2005) Vitamin D. Am J Physiol Renal Physiol 289(1):F8–28. https://doi.org/10.1152/ajprenal.00336.2004

    Article  CAS  PubMed  Google Scholar 

  41. Brown AJ, Dusso A, Slatopolsky E (1999) Vitamin D. Am J Physiol 277(2):F157–175. https://doi.org/10.1152/ajprenal.1999.277.2.F157

    Article  CAS  PubMed  Google Scholar 

  42. Minasyan A, Keisala T, Zou J, Zhang Y, Toppila E, Syvala H, Lou YR, Kalueff AV, Pyykko I, Tuohimaa P (2009) Vestibular dysfunction in vitamin D receptor mutant mice. J Steroid Biochem Mol Biol 114(3–5):161–166. https://doi.org/10.1016/j.jsbmb.2009.01.020

    Article  CAS  PubMed  Google Scholar 

  43. von Brevern M, Lezius F, Tiel-Wilck K, Radtke A, Lempert T (2004) Benign paroxysmal positional vertigo: current status of medical management. Otolaryngol Head Neck Surg 130(3):381–382. https://doi.org/10.1016/j.otohns.2003.07.007

    Article  Google Scholar 

Download references

Funding

This study was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (no. NRF-2016R1D1A1B04935568).

Author information

Authors and Affiliations

  1. Department of Neurology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea

    Seong-Hae Jeong

  2. Department of Neurology, Korea University Medical Center, Seoul, Republic of Korea

    Sun-Uk Lee

  3. Department of Neurology, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, Seoul, 463-707, Korea

    Ji-Soo Kim

  4. Dizziness Center, Seoul National University Bundang Hospital, Seongnam, Korea

    Ji-Soo Kim

Authors
  1. Seong-Hae Jeong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sun-Uk Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ji-Soo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SHJ acquired and analyzed the data, and drafted the manuscript. SUL acquired and analyzed the data, and revised the manuscript. JSK conceptualized and supervised the study, and revised the manuscript.

Corresponding author

Correspondence to Ji-Soo Kim.

Ethics declarations

Conflict of interest

The authors report no disclosure relevant to the manuscript.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 15 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jeong, SH., Lee, SU. & Kim, JS. Prevention of recurrent benign paroxysmal positional vertigo with vitamin D supplementation: a meta-analysis. J Neurol 269, 619–626 (2022). https://doi.org/10.1007/s00415-020-09952-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-020-09952-8

Keywords

Search

Navigation