Seasonality of Benign Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV), an idiopathic condition for patients, occurs when otoconia of the utricular macula become dislodged and floating debris moves into semicircular canals.

Recently, researchers have noted patients with BPPV tend to have low serum vitamin D levels compared with controls. BPPV sufferers develop osteoporosis more often than people who do not have BPPV. BPPV also recurs more frequently in patients with osteoporosis compared with those with normal bone mineral density.

This observation called for an investigation of BPPV’s relationship to vitamin D deficiency. Researchers from Harvard Medical School in Boston Massachusetts extended that theory to seasonality since vitamin D levels fall during winter, and enter a nadir in early spring. They found that BPPV visits did indeed peak in March through May.

This study published in the November issue of JAMA Otolaryngology, assessed the number of BPPV visits seen at a hospital in Boston throughout the year.

BPPV visits increased during the months when serum vitamin D levels are apt to be lowest in Boston. In this study, patients made 956 visits for BPPV over 5 years in the hospital’s otology clinic, laryngology clinic or emergency department. The mean of 5-year pooled BPPV visits in early spring months was significantly greater than that for non—early spring months.

Experts noted that vitamin D’s role in mineralization of otoconia is unclear. They postulated that bone and otoconia share some risk factors for demineralization. A clinical trial is underway to determine whether treatment with cholecalciferol plus calcium prevents recurrent BPPV.

The researchers indicated that future studies need to include consideration of seasonality and BPPV. Additionally, the study suggested BPPV recurrences may be related to season and vitamin D deficiency may be a risk factor for a seasonal form of BPPV.