Vestibular-evoked myogenic potentials and subjective visual vertical testing in patients with vitamin D deficiency/insufficiency

Abstract

Otolith function in subjects with vitamin D deficiency/insufficiency is investigated through vestibular-evoked myogenic potentials (VEMP) and subjective visual vertical (SVV) testing. The study group included 62 patients with vitamin D deficiency/insufficiency (30 females, 32 males), with age range 24-56 years (40.6 ± 9.1). The control group included 44 healthy volunteers of similar age and gender distribution. The entire study group had: (1) serum level of 25-hydroxyvitamin D <30 ng/ml; (2) normal bone mineral density as indicated by dual-energy X-ray absorptiometry with T-score >-1; (3) normal middle ear function; (4) Age is ≤60 years. All subjects enrolled in the current study underwent audiovestibular evaluation consisting of pure-tone audiometry, immittancemetry, cervical VEMP (cVEMP), ocular VEMP (oVEMP), and SSV. The entire control group had normal cVEMP, two subjects had abnormal oVEMP. Thirty-three subjects (53%) in the study group had abnormal oVEMP and 31 subjects (50%) had abnormal cVEMP. Forty-one (66%) had abnormal VEMP when abnormal VEMP was considered as either abnormal oVEMP or cVEMP. The entire control and study groups had normal SSV test results. Vitamin D deficiency may be associated with development of otolith dysfunction affecting both the utricle and saccule. This was suggested by the high prevalence of abnormal ocular vestibular-evoked myogenic potentials (oVEMP) and cervical vestibular-evoked myogenic potentials (cVEMP) in the study group.

Investigating the Association Between Serum Vitamin D Deficiency and Idiopathic Benign Paroxysmal Positional Vertigo

“…19,20 Sanyelbhaa and Sanyelbhaa noted that vitamin D3 deficiency leads to the formation of abnormal otoconia in the inner ear, which results in otolith dysfunction of the inner ear. 21 Dynamic calcium uptake also causes otolith of utricle in the inner ear, and this process is well related to calcium-binding proteins that are up-regulated by vitamin D3. 22 Vestibular dysfunction is observed in mice without the vestibular D3 receptor.…”

Analysis of effect of 1α-hydroxyvitamin D3 on benign paroxysmal positional vertigo and risk factors

“…It is important to maintain a low calcium ion concentration in the vestibule of inner ear, because it can prevent the production of abnormal crystals in the endolymph ( 12 , 13 ). The calcium uptake will be increased when the free calcium concentration in the endolymph increase, reducing the ability of endolymph of dissolving the fallen otoliths ( 14 , 15 ). In addition, 1,25-hydroxyvitamin D3 in epithelial cells of rat semicircular canal can upregulate the expression of some calcium channel-binding proteins ( 16 ).…”

Nuevo método para evaluar el Test Subjetivo Vertical

“…Sin embargo, esto puede resultar imposible en la actualidad, ya que incluso los o-VEMP que se postulan miden específicamente la función del utrículo parecen no evaluar el mismo aspecto de dicho órgano que el SVV. Diversos estudios muestran la discrepancia existente entre resultados de SVV y o-VEMP en el mismo paciente 7,34 . Por otro lado, la mayoría de los pacientes con una prueba calórica alterada, presentan alteraciones en su función utricular, ya sea medida mediante SVV u o-VEMP, dado que tanto el canal lateral como el utrículo son inervados por el nervio vestibular superior e irrigados por la arteria vestibular anterior.…”