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Association of benign paroxysmal positional vertigo with vitamin D deficiency: a systematic review and meta-analysis

Abstract

Background and objective

Benign paroxysmal positional vertigo (BPPV) is an idiopathic recurrent inner ear illness that is caused most often by an imbalance in the metabolism of calcium carbonate crystals (otoconia) inside the semicircular canals, in which the otoconia begin to circulate freely after being dislodged from the basic structure. The underlying etiology of this imbalance has not yet been well established; however, a few recent articles have revealed that vitamin D level abnormality in these patients might play a role. Therefore, we conducted the current systematic review analysis to explore potential associations of vitamin D level with the occurrence as well as the recurrence of BPPV disease.

Methods

A comprehensive literature search was conducted using different databases to retrieve all of the articles that have evaluated possible associations, irrespective of the study design. Then, we reported different vitamin D3 levels from BPPV groups and control groups to estimate the standardized mean difference (SMD) between the BPPV and control groups. We also calculated the effect size of each study under the random effects statistical model.

Results

Of the 703 studies that we identified, only 37 studies were found to be potential for our analysis, and of these, only seven met our predetermined criteria. Two meta-analyses were conducted with respect to the occurrence and the recurrence of BPPV. When the BPPV cases were compared to the controls (free of BPPV disease), there was an insignificant reduction in vitamin D level among the diseased groups (SMD = − 2.20; 95% CI − 6.66 to 2.26). In contrast, when the recurrent BPPV groups were compared with the non-recurrent BPPV groups, the statistical analysis showed significantly lower level of vitamin D among the recurrence BPPV groups (SMD = − 4.47; 95% CI − 7.55 to − 1.29).

Conclusion

Although a negative vitamin D imbalance has been reported among some BPPV patients, this review analysis failed to establish a relationship between the occurrence of BPPV and low vitamin D level. However, low vitamin D level was significantly evident among patients with recurrent episodes of BPPV.

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References

  1. Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T, Holmberg JM, Mahoney K, Hollingsworth DB, Roberts R, Seidman MD (2017) Clinical practice guideline: benign paroxysmal positional vertigo (update). Otolaryngol Head Neck Surg 156(3_suppl):S1–S47

    Article  Google Scholar 

  2. Schappert SM (1992) National Ambulatory Medical Care Survey: 1989 summary. Vital and health statistics. Series 13, Data from the National Health Survey, vol 110, pp 1–80

  3. Karatas A, Acar Yuceant G, Yuce T, Haci 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 

  4. Hanley K, O’Dowd T, Considine N (2001) A systematic review of vertigo in primary care. Br J Gen Pract 51(469):666–671

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Neuhauser HK, Lempert T (2009) Vertigo: epidemiologic aspects. Semin Neurol 29(05):473–481. (© Thieme Medical Publishers)

    Article  Google Scholar 

  6. Parnes LS, Agrawal SK, Atlas J (2003) Diagnosis and management of benign paroxysmal positional vertigo (BPPV). Can Med Assoc J 169(7):681–693

    Google Scholar 

  7. Nedzelski JM, Barber HO, McIlmoyl L (1986) Diagnoses in a dizziness unit. J Otolaryngol 15(2):101–104

    CAS  PubMed  Google Scholar 

  8. Von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T, Neuhauser H (2007) Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry 78(7):710–715

    Article  Google Scholar 

  9. Oghalai JS, Manolidis S, Barth JL, Stewart MG, Jenkins HA (2000) Unrecognized benign paroxysmal positional vertigo in elderly patients. Otolaryngol Head Neck Surg 122(5):630–634

    CAS  Article  Google Scholar 

  10. Motin M, Keren O, Groswasser Z, Gordon CR (2005) Benign paroxysmal positional vertigo as the cause of dizziness in patients after severe traumatic brain injury: diagnosis and treatment. Brain Inj 19:693–697

    CAS  Article  Google Scholar 

  11. Yu S, Liu F, Cheng Z, Wang Q (2014) Association between osteoporosis and benign paroxysmal positional vertigo: a systematic review. BMC Neurol 14(1):110

    Article  Google Scholar 

  12. Parham K, Leonard G, Feinn RS, Lafreniere D, Kenny AM (2013) Prospective clinical investigation of the relationship between idiopathic benign paroxysmal positional vertigo and bone turnover. Laryngoscope 123(11):2834–2839

    CAS  Article  Google Scholar 

  13. Yang H, Zhao X, Xu Y, Wang L, He Q, Lundberg YW (2011) Matrix recruitment and calcium sequestration for spatial specific otoconia development. PLoS One 6:e20498

    CAS  Article  Google Scholar 

  14. 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

    CAS  Article  Google Scholar 

  15. Talaat HS, Abuhadied G, Talaat AS, Abdelaal MSS (2015) Low bone mineral density and vitamin D deficiency in patients with benign positional paroxysmal vertigo. Eur Arch Otorhinolaryngol 272(9):2249–2253

    Article  Google Scholar 

  16. Işık G, Çevik Y, Emektar E, Çorbacıoğlu ŞK (2017) Analysis of vitamin D and calcium levels in benign paroxysmal positional vertigo. Eurasian J Emerg Med 16(3):128–132. https://doi.org/10.5152/eajem.2017.58077

    Article  Google Scholar 

  17. Maslovara S, Butkovic Soldo S, Sestak A, Milinkovic K, Rogic-Namacinski J, Soldo A (2017) 25 (OH) D3 levels,incidence and recurrence of different clinical forms of benig paroxysmal positional vertigo. Braz J Otorhinolaryngol. https://doi.org/10.1016/j.bjorl.2017.05.007

    Article  PubMed  Google Scholar 

  18. 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.2012.11.029

    CAS  Article  PubMed  Google Scholar 

  19. Gu Il Rhim (2016) Serum vitamin D and recurrent benign paroxysmal positional vertigo. Laryngosc Investig Otolaryngol 1(6):150–153

    Article  Google Scholar 

  20. Minasyan A, Keisala T, Zou J, Zhang Y, Toppila E, Syvälä H, Lou YR, Kalueff AV, Pyykkö I, Tuohimaa P (2009) Vestibular dysfunction in vitamin D receptor mutant mice. J Steroid Biochem Mol Biol 114(3):161–166

    CAS  Article  Google Scholar 

  21. Sheikhzadeh M, Lotfi Y, Mousavi A, Heidari B, Monadi M, Bakhshi E (2016) Influence of supplemental vitamin D on intensity of benign paroxysmal positional vertigo: a longitudinal clinical study. Casp J Intern Med 7(2):93

    Google Scholar 

  22. Talaat HS, Kabel AMH, Khaliel LH, Abuhadied G, El 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

    Article  Google Scholar 

  23. Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13

    Article  Google Scholar 

  24. Ginde AA, Mansbach JM, Camargo CA Jr (2009) Association between serum 25-hydroxyvitamin D level and upper respiratory tract infection in the Third National Health and Nutrition Examination Survey. Arch Intern Med 169:384–390

    CAS  Article  Google Scholar 

  25. Sabetta JR, DePetrillo P, Cipriani RJ, Smardin J, Burns LA, Landry ML (2010) Serum 25-hydroxyvitamin d and the incidence of acute viral respiratory tract infections in healthy adults. PLoS One 5:e11088. https://doi.org/10.1371/journal.pone.0011088

    CAS  Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors are grateful to the department of Family and Community Medicine at King Abdulaziz University in Jeddah, Saudi Arabia for the tremendous efforts they provided during the period of the public health master program. In addition, the authors extend their great thanks to Prof. Michael A. Stoto, Professor of Health System Administration and Population Health at Georgetown University and the Adjunct Professor of Biostatistics and Senior Preparedness Fellow at Harvard T.H. Chan School of Public Health for the outstanding and valuable lectures on systematic reviews and meta-analyses, which helped us to build up the knowledge and skills required to conduct such a study.

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Correspondence to Ahmad A. Mirza.

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AlGarni, M.A., Mirza, A.A., Althobaiti, A.A. et al. Association of benign paroxysmal positional vertigo with vitamin D deficiency: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 275, 2705–2711 (2018). https://doi.org/10.1007/s00405-018-5146-6

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  • DOI: https://doi.org/10.1007/s00405-018-5146-6

Keywords

  • Benign positional paroxysmal vertigo
  • Meta-analysis
  • Systematic review
  • Vitamin D deficiency