Is Vitamin D Deficiency a Cause of Refractory Benign Paroxysmal Positional Vertigo (BPPV)?

<b>Introduction:</b> Vitamin D is crucial for calcium metabolism, and its role in benign paroxysmal positional vertigo (BPPV) pathogenesis has been increasingly recognized. However, its impact on treatment resistance in BPPV patients remains unclear and understudied.<b>Aim:</b> This study investigated the association between treatment resistance in BPPV and various risk factors, including vitamin D deficiency, age, gender, and comorbidities.<b>Materials and methods:</b> A retrospective review of medical records was conductedon 122 patients diagnosed with BPPV at a tertiary care hospital between January2020 and January 2023. The diagnosis of BPPV was confirmed using clinical historyand positional tests, while serum 25-OH vitamin D levels were measured usingchemiluminescence immunoassay. Patients who required three or more canalithrepositioning maneuvers were considered treatment-resistant. Logistic regressionanalysis was employed to assess the impact of demographic and clinical factors onBPPV treatment resistance, and recurrence rates were evaluated over a one-yearfollow-up period.<b>Results:</b> Logistic regression revealed that male gender, comorbidities, and betahistine use were significantly associated with BPPV resistance (p < 0.05), while no significant relationship was found between vitamin D levels and treatment resistance or recurrence (p > 0.05). Recurrence was observed in 22.1% of patients during the follow- -up period, though this was not significantly related to vitamin D status.<b>Conclusions:</b> While previous studies suggested a potential link between vitamin Ddeficiency and BPPV recurrence, this study found no significant association betweenvitamin D deficiency and resistance along with the recurrence of BPPV. Instead, malegender, comorbidities (notably hypertension), and betahistine use were identified asrisk factors for requiring multiple maneuvers. The study raises questions about therole of vitamin D in BPPV pathophysiology and suggests that other clinical factorsmay have a greater influence on treatment outcomes.