Clinical Report: Identifying Risk Factors for Refractory BPPV

Overview

This study investigates the clinical factors associated with refractory benign paroxysmal positional vertigo (BPPV), focusing on serum 25-hydroxyvitamin D levels and BPPV subtype. It finds that lower serum 25(OH)D levels are associated with treatment resistance, particularly in typical BPPV cases.

Background

Benign paroxysmal positional vertigo (BPPV) is a prevalent cause of acute vertigo, typically treated with canalith repositioning procedures (CRPs). However, some patients experience refractory BPPV, requiring multiple CRP attempts. Understanding the factors contributing to treatment resistance is crucial for optimizing management strategies.

Data Highlights

The study evaluated 171 patients with acute BPPV, identifying 47 patients (27.5%) as having refractory BPPV, defined as requiring three or more CRP attempts. Kaplan–Meier analysis indicated that cumulative resolution significantly increased during the first three CRP attempts but plateaued thereafter.

Key Findings

• Refractory BPPV was defined as requiring three or more CRP attempts.
• Lower serum 25-hydroxyvitamin D [25(OH)D] levels were independently associated with treatment resistance.
• BPPV subtype and prior vestibular neuritis were the strongest predictors of treatment resistance.
• Subgroup analysis revealed that lower 25(OH)D levels correlated with treatment resistance only in typical BPPV.
• The inclusion of an interaction term between 25(OH)D and subtype showed a significant subtype-dependent effect.

Clinical Implications

Identifying patients at risk for refractory BPPV may help tailor treatment approaches.

Conclusion

Further research is warranted to explore the underlying mechanisms related to serum 25(OH)D levels and treatment resistance in BPPV.

Related Resources & Content

1. AAO-HNS, Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update), 2017 -- Clinical Practice Guidelines
2. Neurology, Prevention of benign paroxysmal positional vertigo with vitamin D supplementation, 2020 -- Randomized Trial
3. Frontiers in Neurology, Association between vitamin D, vitamin D supplementation and benign paroxysmal positional vertigo, 2025 -- Systematic Review
4. conexiant — Vitamin D May Reflect Myopia Risk
5. The Journal of Clinical Endocrinology & Metabolism — The Relationship Between Serum 25-Hydroxyvitamin D Levels, Genetic Factors, and the Risk of Abdominal Aortic Aneurysm
6. Clinical Rheumatology — An Analysis of Vitamin D Levels Among a Large Group of Patients with Rheumatic Disorders
7. Blood Cancer Journal — Validation of a vitamin D replacement strategy in vitamin D-insufficient patients with lymphoma or chronic lymphocytic leukemia
8. Vitamin D May Reflect Myopia Risk
9. The Relationship Between Serum 25-Hydroxyvitamin D Levels, Genetic Factors, and the Risk of Abdominal Aortic Aneurysm
10. An Analysis of Vitamin D Levels Among a Large Group of Patients with Rheumatic Disorders
11. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) - American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS)
12. Benign paroxysmal positional vertigo: Diagnostic criteria: Consensus document of the Committee for the Classification of Vestibular Disorders of the Bárány Society
13. Prevention of benign paroxysmal positional vertigo with vitamin D supplementation | Neurology
14. Vitamin D supplementation in preventing the recurrence of benign paroxysmal positional vertigo - PMC
15. Association between vitamin D, vitamin D supplementation and benign paroxysmal positional vertigo: a systematic review and meta-analysis - PMC
16. Vitamin D Supplementation for Preventing Recurrent Benign Paroxysmal Positional Vertigo: A Randomized Clinical Study - Hussein Ali Tawfeeq, Mustafa Adnan Zaidan, Ali Kamal Ghanim, 2026
17. Vitamin D Supplementation and Recurrence of Benign Paroxysmal Positional Vertigo - PMC
18. Different clinical course of BPPV according to the medical conditions | Scientific Reports
19. Frontiers | Treatment efficacy of repositioning maneuvers in multiple canal benign paroxysmal positional vertigo: a systematic review and meta-analysis
20. Etiology, Pathophysiology, and Management of Refractory Cases of Benign Paroxysmal Positional Vertigo
21. Risk factors and a nomogram model for recurrence of benign paroxysmal positional vertigo: a multicenter cross-sectional study