Skip to main content

Association between serum vitamin D levels and benign paroxysmal positional vertigo: a systematic review and meta-analysis of observational studies

European Archives of Oto-Rhino-Laryngology volume 277, pages 169–177 (2020)Cite this article

Abstract

Objective

Benign paroxysmal positional vertigo (BPPV) was the most common neuro-otological disorder manifests as recurrent positional vertigo, but its risk factors are elusive. Recent studies suggest that decreased Vitamin D level may be a risk factor, but the literature is inconsistent.

Methods

The databases PubMed, Web of Science, Chinese National Knowledge Infrastructure, Wanfang, SinoMed, and Embase were systematically searched for studies on the association between BPPV and  serum Vitamin D levels published up to June 2019. Data from eligible studies were meta-analyzed using Stata 12.0.

Results

A total of 18 studies were included in the analysis. Serum Vitamin D levels were significantly lower in individuals with BPPV than in controls (WMD − 2.46, 95% CI − 3.79 to − 1.12, p < 0.001). Subgroup analysis by geographical area showed that vitamin D level was significantly lower in BPPV than in controls in China (WMD − 3.27, 95% CI − 4.12 to − 2.43, p < 0.001), but not outside China (WMD − 0.90, 95% CI − 4.36 to 2.56, p = 0.611). Vitamin D levels were significantly lower in recurrent than non-recurrent BPPV across all countries in the sample (WMD 2.59, 95% CI 0.35–4.82, p = 0.023). Vitamin D deficiency emerged as an independent risk factor of BPPV (OR 1.998, 95% CI 1.400–2.851, p < 0.001).

Conclusion

The available evidence suggests that BPPV is associated with decreased levels of serum Vitamin D, and vitamin D deficiency was an independent risk factor for BPPV.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

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

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

References

  1. von Brevern M (2013) Benign paroxysmal positional vertigo. Semin Neurol 33(3):204–211

    Article  Google Scholar 

  2. Lundberg YW, Zhao X, Yamoah EN (2006) Assembly of the otoconia complex to the macular sensory epithelium of the vestibule. Brain Res 1091(1):47–57

    Article  CAS  Google Scholar 

  3. Buki B, Ecker M, Junger H, Lundberg YW (2013) Vitamin D deficiency and benign paroxysmal positioning vertigo. Med Hypotheses 80(2):201–204

    Article  Google Scholar 

  4. 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. https://doi.org/10.1042/BSR20190142

  5. Han W, Fan Z, Zhou M, Guo X, Yan W, Lu X et al (2018) Low 25-hydroxyvitamin D levels in postmenopausal female patients with benign paroxysmal positional vertigo. Acta Otolaryngol 138(5):443–446

    Article  CAS  Google Scholar 

  6. Jeong SH, Kim JS, Shin JW, Kim S, Lee H, Lee AY et al (2013) Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo. J Neurol 260(3):832–838

    Article  CAS  Google Scholar 

  7. Wu Y, Fan Z, Jin H, Guan Q, Zhou M, Lu X et al (2018) Assessment of bone metabolism in male patients with benign paroxysmal positional vertigo. Front Neurol 9:742

    Article  Google Scholar 

  8. Wu YQ, Lu XX, Fan ZY, Zhou M, Li L, Yan W et al (2018) Relationship between 25-hydroxyvitamin D levels and idiopathic benign paroxysmal positional vertigo in female patients. Zhonghua yi xue za zhi 98(16):1223–1226

    CAS  PubMed  Google Scholar 

  9. Zhang Y, Liu B, Tian XB, Bi JT (2019) An analysis of biochemical markers of bone metabolisim in patients with idiopathic benign paroxysmal positional vertigo. J Clin Otorhinolaryngol Head Neck Surg (China) 33:237–241

    CAS  Google Scholar 

  10. Işık GÇY, 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

    Article  Google Scholar 

  11. 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 Equilib Orientat 27(5–6):287–294

    Article  Google Scholar 

  12. 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

    Article  Google Scholar 

  13. Stang A (2010) Critical evaluation of the Newcastle–Ottawa Scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25(9):603–605

    Article  Google Scholar 

  14. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560

    Article  Google Scholar 

  15. Egger M, Smith GD, Phillips AN (1997) Meta-analysis: principles and procedures. BMJ 315(7121):1533–1537

    Article  CAS  Google Scholar 

  16. AlGarni MA, Mirza AA, Althobaiti AA, Al-Nemari HH, Bakhsh LS (2018) Association of benign paroxysmal positional vertigo with vitamin D deficiency: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol Off J Eur Fed Otorhinolaryngol Soc 275(11):2705–2711

    Article  Google Scholar 

  17. Chen WFJ, Shu L, Wu J, Pan H, Sun XH, Dong YR, Liu JR (2017) Serum 25-hydroxyvitamin D is decrease in patients with Benign paroxysmal positional vertigo. Acad J Second Mil Med Univ 38(11):1361–1365

    Google Scholar 

  18. 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

    Article  Google Scholar 

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

    Article  Google Scholar 

  20. 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 Off J Eur Fed Otorhinolaryngol Soc 272(9):2249–2253

    Article  Google Scholar 

  21. Wang QRJY (2018) Study on biochemical markers of bone transformation in benign paroxysmal positional vertigo. Neural Inj Funct Reconstr 13(11):578–580

    Google Scholar 

  22. Zhang XLZN, Chen JX, Wu HY (2018) Analysis of bone mineral density, serum calcium concentration and Vitamin D status in postmenpausal women with benign paroxysmal positional vertigo. J Audiol Speech Pathol 26(6):576–579

    Google Scholar 

  23. Lee SB, Lee CH, Kim YJ, Kim HM (2017) Biochemical markers of bone turnover in benign paroxysmal positional vertigo. PLoS One 12(5):e0176011

    Article  Google Scholar 

  24. Zucca G, Valli S, Valli P, Perin P, Mira E (1998) Why do benign paroxysmal positional vertigo episodes recover spontaneously? J Vestib Res Equilib Orientat 8(4):325–329

    Article  CAS  Google Scholar 

  25. Yamauchi D, Nakaya K, Raveendran NN, Harbidge DG, Singh R, Wangemann P et al (2010) Expression of epithelial calcium transport system in rat cochlea and vestibular labyrinth. BMC Physiol 10:1

    Article  Google Scholar 

  26. Minasyan A, Keisala T, Zou J, Zhang Y, Toppila E, Syvala H et al (2009) Vestibular dysfunction in vitamin D receptor mutant mice. J Steroid Biochem Mol Biol 114(3–5):161–166

    Article  CAS  Google Scholar 

  27. 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):93–98

    Google Scholar 

  28. Talaat HS, Kabel AM, Khaliel LH, Abuhadied G, El-Naga HA, 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 

Download references

Acknowledgements

This research was supported by the Yunnan Applied Basic Research Project (201801CH00572), National Natural Science Foundation of China (81860247, 81960242), Yunnan Province Medical Health Research Institute Project (2018NS0102), The First Affiliated Hospital of Kunming Medical University Doctoral Research Fund Project (2017BS005) and "One hundred Young and Middle-aged Academic and Technical backbone" Training Program of Kunming Medical University (60118260105).

Author information

Authors and Affiliations

  1. Department of Neurology, Seventh People’s Hospital of Chengdu, Chengdu, 610041, Sichuan, People’s Republic of China

    Baiyuan Yang, Wei Zhong & Qing Tang

  2. Department of Endocrinology, Seventh People’s Hospital of Chengdu, Chengdu, 610041, Sichuan, People’s Republic of China

    Yongxia Lu & Jingyu Liu

  3. Department of Neurology, The Third People’s Hospital of Yunnan Province, Kunming, 650011, Yunnan, People’s Republic of China

    Dongmei Xing

  4. Department of Geriatric Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, People’s Republic of China

    Xinglong Yang

Authors
  1. Baiyuan Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yongxia Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dongmei Xing
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wei Zhong
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Qing Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jingyu Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Xinglong Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xinglong Yang.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Baiyuan Yang, Yongxia Lu and Dongmei Xing contribute equally to the present research.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOC 128 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Yang, B., Lu, Y., Xing, D. et al. Association between serum vitamin D levels and benign paroxysmal positional vertigo: a systematic review and meta-analysis of observational studies. Eur Arch Otorhinolaryngol 277, 169–177 (2020). https://doi.org/10.1007/s00405-019-05694-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-019-05694-0

Keywords

  • Benign paroxysmal positional vertigo
  • Otolithiasis
  • Serum vitamin D
  • Meta-analysis