25 (OH) D3 levels, incidence and recurrence of different clinical forms of benig paroxysmal positional vertigo

Braz J Otorhinolaryngol. 2018;84(4):453---459 Brazilian Journal of OTORHINOLARYNGOLOGY www.bjorl.org ORIGINAL ARTICLE 25 (OH) D3 levels, incidence and recurrence of different clinical forms of benig paroxysmal positional vertigo夽 Sinisa Maslovara a,b,∗ , Silva Butkovic Soldo c,d , Anamarija Sestak a , Katarina Milinkovic a , Jasna Rogic-Namacinski a,e , Anamarija Soldo c,d a County General Hospital, Department of Otolaryngology, Vukovar, Croatia University of Osijek, Medical Faculty, Department of Otorhinolaryngology and Maxillofacial Surgery, Osijek, Croatia c Clinical Hospital Center, Department of Neurology, Osijek, Croatia d University of Osijek, Medical Faculty, Department of Neurology, Osijek, Croatia e County General Hospital, Department of Laboratory Diagnostic, Vukovar, Croatia b Received 27 February 2017; accepted 22 May 2017 Available online 11 June 2017 KEYWORDS Benign paroxysmal positional vertigo; Vitamin D3 insufficiency; Recurrence; Clinical forms Abstract Introduction: Benign paroxysmal positional vertigo is the most common cause of dizziness in the general population. It is a condition with potential impact of reduced levels of vitamin D on its recurrent attacks. Objectives: The aim of this study was to measure the serum levels of 25-hydroxyvitamin D3 (25-OH D3) in patients with benign paroxysmal positional vertigo and determine whether there is a difference in the serum levels of vitamin D3 between patients with and without recurrence, as well as between the different clinical forms of benign paroxysmal positional vertigo. Methods: The study included 40 patients who came to the regular medical examination, diagnosed with posterior canal-benign paroxysmal positional vertigo based on the positive DixHallpike’s test. All patients underwent Epley manoeuvre after the diagnosis. Patients were classified according to current guidelines for levels of vitamin D3 in the serum in three groups: the deficiency, insufficiency and adequate level. Results: The average serum level of 25-OH D3 among respondents was 20.78 ng/mL, indicating a lack or insufficiency of the aforementioned 25-OH D3. According to the levels of 25-OH D3, most patients suffer from deficiency (47.5%). 7 (17.5%) respondents had adequate blood level of 25-OH D3, and 14 (35%) respondents suffer from insufficiency. A significant difference was 夽 Please cite this article as: Maslovara S, Butkovic Soldo S, Sestak A, Milinkovic K, Rogic-Namacinski J, Soldo A. 25 (OH) D3 levels, incidence and recurrence of different clinical forms of BPPV. Braz J Otorhinolaryngol. 2018;84:453---9. ∗ Corresponding author. E-mail: (S. Maslovara). Peer Review under the responsibility of Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. https://doi.org/10.1016/j.bjorl.2017.05.007 1808-8694/© 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). 454 Maslovara S et al. was not found in the serum level of 25-OH D3 between patients with and without benign paroxysmal positional vertigo recurrence. There was a significant difference in the serum levels of 25-OH D3 in comparison to the clinical form of the disease. Lower 25-OH D3 values were found in patients with canalithiasis compared to those with cupulolithiasis. Conclusions: There were no significant differences in the vitamin D3 serum level in patients with and without recurrence. The study showed a low level of serum vitamin D3 in most patients, indicating the need for supplemental therapy. © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/). PALAVRAS-CHAVE Vertigem posicional paroxística benigna; Insuficiência da vitamina D3; Recorrência; Formas clínicas Níveis de 25 (OH) D3, incidência e recorrência de diferentes formas clínicas de vertigem posicional paroxística benigna Resumo Introdução: Vertigem posicional paroxística benigna é a causa mais comum de tonturas na população em geral. É uma condição no qual níveis reduzidos de vitamina D podem ter um potencial impacto para o desenvolvimento de crises recorrentes. Objetivos: O objetivo desse estudo foi medir os níveis séricos de 25-hidroxivitamina D3 (25-OH D3) em pacientes com vertigem posicional paroxística benigna e determinar se há diferença nos níveis séricos de vitamina D3 entre pacientes com e sem recorrência, bem como entre as diferentes formas clínicas de vertigem posicional paroxística benigna. Método: O estudo incluiu 40 pacientes submetidos a exame médico regular, diagnosticados com vertigem posicional paroxística benigna de canal posterior baseado no resultado positivo do teste de Dix-Hallpike. Todos os pacientes foram submetidos à manobra de Epley após o diagnóstico. Os pacientes foram classificados de acordo com as diretrizes atuais para os níveis de vitamina D3 sérica em três grupos: deficiência, insuficiência e nível adequado. Resultados: O nível sérico médio de 25-OH D3 entre os indivíduos avaliados foi de 20,78 ng/mL, indicando falta ou insuficiência desta vitamina. De acordo com os níveis de 25-OH D3, a maioria dos pacientes apresentou deficiência (47,5%). Sete indivíduos (17,5%) entrevistados tinham nível sanguíneo adequado de 25-OH D3 e 14 (35%) apresentavam insuficiência. Não foi encontrada diferença significativa no nível sérico de 25-OH D3 entre pacientes com e sem recidiva de vertigem posicional paroxística benigna. Houve uma diferença significativa nos níveis séricos de 25-OH D3 de acordo com a forma clínica da doença. Baixos níveis de 25-OH D3 foram mais encontrados em pacientes com canalitíase em comparação com aqueles com cupulolitíase. Conclusões: Não houve diferenças significativas no nível sérico de vitamina D3 em pacientes com e sem recorrência. O estudo mostrou um baixo nível de vitamina D3 sérica na maioria dos pacientes, indicando a necessidade de terapia suplementar. © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Publicado por Elsevier Editora Ltda. Este é um artigo Open Access sob uma licença CC BY (http:// creativecommons.org/licenses/by/4.0/). Introduction Benign paroxysmal positional vertigo (BPPV) is the most common cause of dizziness in the general population with a lifetime prevalence of about 10%.1 The disease occurs spontaneously, clinically manifests in short seizures, intensive vertigos that are caused by a certain position of the head and are often accompanied by vegetative symptoms. After placing the head in the inciting position, typical verticaltorsional nystagmus can be seen. The illness usually lasts for a few days or weeks and then spontaneously ceases,2 but it can also prolong to several months or even exceed and become chronic or recurrent. Pathophysiological mechanisms (...truncated)