A patient returning with positional vertigo for the third time usually gets a third repositioning manoeuvre. It works, and then they come back again.
Today's trial offers a way to change that trajectory in a specific group. In patients with recurrent BPPV and a 25-hydroxyvitamin D below 20 ng/mL, weekly cholecalciferol halved recurrence over two years, with fewer than four patients needing treatment to prevent one recurrence. The test is inexpensive and widely available, and in populations where deficiency is common a substantial proportion of recurrent BPPV patients will qualify.
So add a vitamin D level to the workup of recurrent BPPV, and treat if it is low. Two caveats keep this honest: the evidence covers deficient patients only, so there is no basis for supplementing someone with a normal level, and this prevents recurrence rather than treating the current episode — the patient still needs their repositioning manoeuvre today.
- Measure 25-hydroxyvitamin D in recurrent BPPV
- Treat if below 20 ng/mL — recurrence halved, NNT 3.6 over two years
- No evidence for supplementing patients who are already replete
- Prevention, not treatment: still perform the repositioning manoeuvre
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