title: Reduction of recurrence rate of benign paroxysmal positional vertigo by treatment of severe vitamin D deficiency.
abstract: OBJECTIVE
  Several studies correlated between vitamin D deficiency and the development, and the recurrence of benign positional paroxysmal vertigo (BPPV), but none of them proved that treatment of vitamin D deficiency would reduce the recurrence rate of BPPV. This study aims to detect the effect of treatment of severe vitamin D deficiency on the recurrence rate of BPPV.
  
  
  METHODS
  The inclusion criteria of the study group were: (1) Unilateral, idiopathic, posterior canal BPPV with no history suggestive of secondary BPPV and (2) 25-hydroxyvitamin D3 level ≤10 ng/ml. All subjects enrolled in the current study underwent detailed clinical history, audiovestibular evaluation consisting of pure-tone audiometry, Immittancemetry, Videonystugmography, serum 25-hydroxyvitamin D3 assessment, and Dual-energy X-ray absorptiometry (DXA). Vitamin D therapy was prescribed for the study group. Serum 25-hydroxyvitamin D3 level was evaluated twice, on recruitment into the study group and 3 months after commencing vitamin D therapy. According to the results of the second evaluation of serum 25-hydroxyvitamin D3, the study group was subdivided into two subgroups: Subgroup (I): including 28 subjects who disclosed elevation of serum 25-hydroxyvitamin D3 level; improvement ≥10 ng/ml. Subgroup (II): including 65 patients who disclosed elevation of serum 25-hydroxyvitamin D3 levels <10 ng/ml. The study group was followed up for 18 months in order to observe the recurrence of BPPV.
  
  
  RESULTS
  The differences between both study subgroups (I) & (II) regarding age, sex distribution, and bone mineral density were insignificant. The number of subjects who had recurrence of BPPV in subgroup (I) was 4 (14%) versus 28 subjects (43%) in subgroup (II). The mean values for recurrent attacks/subject in subgroups (I) & (II) were 0.18, and 0.66 attack/subject respectively; these differences between both subgroups were of high statistical significance (p<0.01). The Odds Ratio for development of recurrence of BPPV in subjects with severe vitamin D deficiency was 4.54 (95% CI: 1.41-14.58, p<0.01). The relapse attacks of BPPV affected both ears irrespective of the ear showing the original BPPV attack.
  
  
  CONCLUSIONS
  The present study indicates that improvement of serum 25-hydroxyvitamin D3 levels is associated with substantial decrease in recurrence of BPPV.
authors.affiliation: Audiology Unit, Otolaryngology Department, Menoufia University, Egypt. Electronic address: Sanyelbhaa@yahoo.com.
authors.forename: Hossam Sanyelbhaa
authors.initials: HS
authors.lastname: Talaat
authors.affiliation: Audiology Unit, Otolaryngology Department, Menoufia University, Egypt.
authors.forename: Abdel-Magied Hasan
authors.initials: AM
authors.lastname: Kabel
authors.affiliation: Audiology Unit, Otolaryngology Department, Ain Shams University, Egypt.
authors.forename: Lobna Hamed
authors.initials: LH
authors.lastname: Khaliel
authors.affiliation: Audiology Unit, Otolaryngology Department, Bani Sweef University, Egypt.
authors.forename: Ghada
authors.initials: G
authors.lastname: Abuhadied
authors.affiliation: Otolaryngology Department, Menoufia University, Egypt.
authors.forename: Heba Abd El-Rehem Abo
authors.initials: HA
authors.lastname: El-Naga
authors.affiliation: Internal Medicine Department, Suiz Canal University, Egypt.
authors.forename: Ahmed Sanyelbhaa
authors.initials: AS
authors.lastname: Talaat
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D065635:Benign Paroxysmal Positional Vertigo / Q000453:epidemiology / Q000517:prevention & control*; D015519:Bone Density; D002112:Calcifediol / Q000097:blood; D002762:Cholecalciferol / Q000627:therapeutic use*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012720:Severity of Illness Index; D014808:Vitamin D Deficiency / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D014815:Vitamins / Q000627:therapeutic use*
chemical_list: D014815:Vitamins; D002762:Cholecalciferol; D002112:Calcifediol
keywords: BPPV recurrence; Dizziness; Vertigo; Vitamin D deficiency