Age-Related Increases in Benign Paroxysmal Positional Vertigo Are Reversed in Women Taking Estrogen Replacement Therapy: A Population-Based Study in Taiwan

Abstract

Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo. Numerous investigations have reported an increased BPPV incidence in females and in the aged population. The hormonal characteristics of BPPV patients have not been previously investigated. This study aimed to determine the risk of BPPV in relation to menopause in a population-based study.Materials and Methods: This retrospective population-based study was designed to use a nationwide longitudinal health insurance database to follow and analyze the incidence of and protective factors against BPPV in a Taiwanese population.Data Analyses: Univariate and multivariate analyses were performed to calculate the adjusted hazard ratio (aHR) for the incidence of BPPV using Cox-proportional regression models.Results: In the multivariate analyses, we found that older people (older than 65 years old) were more prone to develop BPPV (aHR: 5.37, 95% CI: 0 4.83–5.97, p < 0.001). The risk of BPPV was analyzed in two specific age subgroups of elderly females. Results revealed that in both age groups (45–65 years old and >65 years old), patients who took estrogen for menopausal syndromes had a significantly lower incidence of BPPV (aHR; 0.01, 95% CI: 0.06–0.23, p < 0.001).Conclusion: Our study provides a novel etiology and possible treatment method for the prevention of BPPV. Further studies may focus on the pathophysiological mechanism of estrogen in BPPV patients and the development of new drugs for the prevention and treatment of BPPV.

Aging and the peripheral vestibular system

“…It accounts for 8% of dizziness/vertigo in the general population (von Brevern et al, 2007), 34% of dizziness in persons aged 50 years and older (Davis, 1994), and 39% of dizziness in persons 70 years and older (Katsarkas, 1994). The prevalence of BPPV increases with age such that it is seven times higher in those aged 65 years and over relative to those aged 15–40 years (Liu et al, 2017; von Brevern et al, 2007).…”

Seasonality and Cardio-Cerebrovascular Risk Factors for Benign Paroxysmal Positional Vertigo

“…Similarly, in the present study, there is a predominance of female sex, accounting for about 67.2% of BPPV patients. This female preponderance may be linked to hormonal factors (25). Estrogen deficiency has been shown to disturb the internal structure of the otoconia and their interconnection and attachment to the matrix (26).…”

Clinical Characteristics of Patients With Benign Paroxysmal Positional Vertigo Diagnosed Based on the Diagnostic Criteria of the Bárány Society

“…The reduction in estrogen levels may lead to systemic disturbances in calcium metabolism and affect the synthesis and function of otoliths (13). Studies have found that the incidence of BPPV in women receiving hormone replacement therapy for menopausal symptoms was significantly reduced (14). Bárány Society's diagnostic criteria for BPPV is a diagnostic guideline jointly created by vestibular specialists from many countries.…”