D-Vitamin and BPPV

By:Karl Nordfalk

BPPV is caused by calcium-carbonate crystals that dislodges from the utricle and move into the semi-circular canals. The crystals contain calcium and D-Vitamin is important for regulating calcium. Because of this several studies have examined the relation between D-Vitamin levels and BPPV.

Vitamin levels are measured in 25(OH)D
(=sum of 25(OH)D2 + 25(OH)D3) and can be reported in ng/ml or nmol/l. All values are converted to nmol/l in this report since this is the current standard in the Nordic countries. For conversion: ng/ml x 2.5 = nmol/l.

Jeong et al. reported that patients with BPPV have significantly lower D-Vitamin levels (36 nmol/l) than a general population (47.5 nmol/l). Since this is cross-sectional study it is not possible to say if low D-Vitamin is the cause or effect of BPPV in the study group.

Talaat et al. examined individuals who both had BPPV and low D-Vitamin levels (<25 nmol/l). They gave D-Vitamin supplement and found that individuals who responded well to treatment and increased their 25(OH)D level by more than 25 nmol/l had fewer BPPV attacks.

Should we administer supplementary D-Vitamin to BPPV patients?
– The evidence level that D-Vitamin helps reduce BPPV attacks is quite low (IIb/3) but small studies indicate that increasing D-Vitamin might decrease the risk for recurrent BPPV. If a patient suffers from recurrent BPPV it is possible, but not proved, that increasing the D-Vitamin levels might help reduce attacks.

What serum level 25(OH)D should we aim for in BPPV patients?
– The optimal D-Vitamin level is, as of June 2017, still controversial. A 2017 review concluded that the most advantageous serum levels for 25(OH)D for all outcomes appeared to be close to 75 nmol/l. This level is also recommended by D-Vitamin producers. A Nordic consensus group from 2017 recommended 50 nmol/l as goal level.

Jeong SH, Kim JS, Shin JW, Kim S, Lee H, Lee AY, Kim JM, Jo H, Song J, Ghim
Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo.
J Neurol. 2013 Mar;260(3):832-8. Pubmed link

Talaat HS, Kabel AM, Khaliel LH, Abuhadied G, El-Naga HA, Talaat AS.
Reduction of recurrence rate of benign paroxysmal positional vertigo by treatment of severe vitamin D deficiency.
Auris Nasus Larynx. 2016 Jun;43(3):237-41. Pubmed link

Optimal serum 25-hydroxyvitamin D levels for multiple health outcomes. Advances in Experimental Medicine and Biology (Review). 2014. 810: 500–25.
Pubmed link

Brustad M, Meyer HE.
Vitamin D–how much is enough, and is more better for your Health?

Tidsskr Nor Laegeforen. 2014 Apr 8;134(7):726-8. doi:10.4045/tidsskr.13.1513.
Tidsskriftet link

Treatment in TRV-Chair

By: Karl Nordfalk

The TRV Chair was designed by Thomas Richard-Vitton for diagnosis and treatment of Benign Paroxysmal Positional Vertigo (BPPV). BPPV can in many cases be treated with traditional maneuvers on bench such as the Epley, Semont, BBQ, Gufoni and Appiani.

With the TRV chair the sensitivity of the diagnostics and effectiveness of the maneuvers can be enhanced by following the exact plane of the canal and by adding kinetic energy to the maneuvers. With the TRV chair it is also  possible to treat patients with neck and back problems.

West et al. described 150 subjects who were treated with the TRV chair or another bi-axial rotational device, the Epley Omiax, at Rikshospitalet in Copenhagen. 91.7–100 % of the subjects experienced reduction of symptoms after 1-3 treatments. Horizontal cupulolithiasis and multi-canal affection constituted the most difficult cases to treat and cure.

Tan et al. performed a non-randomized prospective study of 165 subjects with posterior canal BPPV and found that 85.2% of the subjects were cured after one week the TRV-chair group compared to 72.6% in the group who received standard treatment. The difference was statistically significant.

West N, Hansen S, Møller MN, Bloch SL, Klokker M. Repositioning chairs in benign paroxysmal positional vertigo: implications and clinical outcome.
Eur Arch Otorhinolaryngol. 2016 Mar;273(3):573-80
Pubmed link

Tan J, Yu D, Feng Y, Song Q, You J, Shi H, Yin S.
Comparative study of the efficacy of the canalith repositioning procedure versus the vertigo treatment and rehabilitation chair.
Acta Otolaryngol. 2014 Jul;134(7):704-8
Pubmed link

Richard-Vitton T, Viirre E.
Unsteadiness and drunkenness sensations as a new sub-type of BPPV.
Rev Laryngol Otol Rhinol (Bord). 2011;132(2):75-80.
Pubmed link


Home treatment for BPPV

Click here for Norwegian text

Before you start with these exercises it is important that you have been diagnosed by a spesialist on BPPV.

Treatment for BPPV in the right posterior semicircular canal. -> Can be performed 1-2 times morning and evening
– Semont maneuver right

Treatment for BPPV in the left posterior semicircular canal. -> Can be performed 1-2 times morning and evening
– Semont maneuver left

Treatment for BPPV in the right horizontal semicircular canal -> Can be performed 1-2 times morning or/and evening.
-BBQ maneuver right

Treatment for BPPV in the left horizontal semicircular canal -> Can be performed 1-2 times morning or/and evening.
-BBQ maneuver left

Treatment for BPPV in the anterior semicircular canals. -> Perform once/day. Stop if you experience pain in the neck region.
– Deep Head Hanging Maneuver