The Role of Comorbidities in Benign Paroxysmal Positional Vertigo

Abstract

Purpose: To assess the correlation between the comorbidities, such as hypertension, diabetes, thyroid disorders, hearing loss, hyperlipidemia, and vitamin D deficiency and benign paroxysmal positional vertigo (BPPV) and to determine the high-risk groups for recurrence of symptoms. Design: Descriptive analytical study. Materials and Methods: Patients who met the inclusion criteria underwent complete ear, nose, and throat examination, including Dix-Hallpike test and roll-over test and blood pressure recording. Investigations included pure tone audiometry, random blood sugar/fasting blood sugar, serum thyroid-stimulating hormone, fasting serum total cholesterol, and serum vitamin D levels. Patients were followed up for a period of 6 months to 1 year. Results: Older age-group has an increased risk of BPPV and recurrence of symptoms. About 45.1% of the patients with BPPV who were detected to have symptoms of hypertension were also more common with hypertensive. Diabetes mellitus was found to have an increased risk of BPPV and its recurrence. The presence of other comorbidities, such as abnormal thyroid function test (9%), sensorineural hearing loss (14%), hypercholesterolemia (46%), and vitamin D deficiency (79%) didn’t show any significant risk for recurrence. Conclusion: The presence of comorbidities worsens the status of BPPV, causing more frequent otolith detachment. Hence, it increases the risk of recurrence even after successful repositioning maneuver. Patients presenting with BPPV should therefore be evaluated and treated for these comorbidities along with the repositioning maneuvers.

Risk Factors for Recurrence of Benign Paroxysmal Positional Vertigo. A Clinical Review

“…Thirty articles examined 14 risk factors for recurrence of BPPV and they included 12,585 participants ( Table 2 ). Twenty-three were retrospective studies [ 1 , 2 , 3 , 4 , 6 , 7 , 8 , 10 , 11 , 12 , 13 , 16 , 18 , 19 , 20 , 21 , 23 , 24 , 25 , 26 , 29 , 30 , 31 ] and seven were prospective cohort studies [ 5 , 14 , 15 , 17 , 22 , 27 , 28 ]. In all studies, the diagnosis of BPPV was established by positive positional tests (Dix-Hallpike, roll tests).…”

“…Follow-up time . Nine studies [ 2 , 13 , 15 , 18 , 20 , 21 , 23 , 24 , 25 ] had a follow-up duration greater than 6 months to less than a year, reporting a recurrence rate (RR) in the range of 13.7% [ 25 ] to 48% [ 23 ]. Furthermore, ten studies [ 3 , 4 , 5 , 6 , 7 , 11 , 14 , 27 , 28 , 31 ] had a follow-up time ≥2 years with a recurrence rate varying from 13.3% [ 11 ] to 65% [ 28 ].…”

“…Benign paroxysmal positional vertigo (BPPV) is the commonest peripheral vestibular condition encountered in a neurotology clinic and it accounts for about 20% to 30% of all the vestibular complaints [ 1 , 2 , 3 ]. The mechanism of BPPV has been based on dislodged otoliths that leave the utricle and freely float in the semicircular canals or attach to the cupula, making the labyrinth sensitive to gravitational forces.…”

“…The frequent recurrence of BPPV may cause great inconvenience in the daily life of patients with reoccurring BPPV. Many recent studies found that BPPV can be associated with other comorbidity diseases, including hypertension, diabetes, thyroid disorders, hyperlipidemia, and osteoporosis and may be responsible for increased frequency of recurrence of BPPV following treatment [ 2 ]. If such a correlation between common comorbidities and BPPV exists, appropriate treatment of these conditions may be useful in limiting chronicity and reducing the frequency of recurrence.…”

Comparison between efficacy of Epley’s maneuver with medical therapy versus medical therapy alone in treating BPPV patients

“…16 It is believed that the increased risk for BPPV and its recurrence with hypertension is due to the vascular damage caused by hypertension, which will cause labyrinthine ischemia and thus otoconial detachment. 17…”