Risk factors for refractory BPPV: subtype-dependent association of serum 25-hydroxyvitamin D

Benign paroxysmal positional vertigo (BPPV) generally responds well to canalith repositioning procedures (CRPs), although some patients require repeated interventions. In this study, we evaluated refractory BPPV based on the number of CRP attempts required in 171 patients with acute BPPV and investigated clinical factors associated with treatment resistance, with particular emphasis on serum 25-hydroxyvitamin D...

Low serum vitamin D appears to be a subtype-dependent risk factor for refractory BPPV; clinicians managing treatment-resistant BPPV cases should consider checking and potentially optimising vitamin D levels, though prospective confirmatory trials are still needed before making this a routine protocol change.

Identifying modifiable risk factors like vitamin D deficiency for refractory BPPV could guide more personalised management strategies and reduce the burden of repeated repositioning procedures in clinical practice.

1. 01Refractory BPPV (resistance to canalith repositioning procedures) is associated with serum 25-hydroxyvitamin D levels.
2. 02The vitamin D–BPPV resistance link is subtype-dependent, meaning not all BPPV variants are equally affected.
3. 03Vitamin D is an accessible, measurable, and potentially modifiable risk factor.
4. 04Study published in Frontiers in Neurology (DOI: 10.3389/fneur.2026.1838362).
5. 05Findings align with prior literature suggesting vitamin D plays a role in otoconia (inner-ear crystal) metabolism.

PMID

42318244

DOI

10.3389/fneur.2026.1838362.

Journal

Frontiers in Neurology

Publication type

research_article

Evidence level

3

Population

Patients with benign paroxysmal positional vertigo (BPPV) undergoing canalith repositioning procedures

Intervention

Serum 25-hydroxyvitamin D level assessment as a risk factor

Comparator

Patients with non-refractory BPPV who responded to canalith repositioning