- Design
- Randomised, double-blind, placebo-controlled trial, 2 centres
- Population
- 160 adults with idiopathic BPPV and 25(OH)D below 20 ng/mL
- Primary outcome
- BPPV recurrence over 24 months
- Effect
- 27.5% vs 55.0% at 24 months; 50% relative reduction; NNT 3.6
In this double-blind, placebo-controlled trial at two ENT centres in Baghdad, 160 adults with idiopathic BPPV and serum 25-hydroxyvitamin D below 20 ng/mL were randomised to cholecalciferol 10,000 IU weekly or placebo for 24 months.
Recurrence was lower with vitamin D at every point: 15.0% vs 35.0% at six months and 27.5% vs 55.0% at 24 months, a 50% relative reduction and a number needed to treat of 3.6. Vitamin D levels rose to 24.8 vs 9.8 ng/mL. No hypercalcaemia occurred, and adherence exceeded 94%.
Recurrence is the frustrating part of BPPV, with about half of the placebo group relapsing within two years. A cheap, safe supplement that halves it in deficient patients is worth acting on.
Vitamin D deficiency is very common in India, so a large share of patients with recurrent BPPV are likely to qualify. Test, and supplement those who are deficient.
- Check 25-hydroxyvitamin D in patients with recurrent BPPV.
- Supplement those below 20 ng/mL; the trial used cholecalciferol 10,000 IU weekly.
- Continue repositioning manoeuvres for each episode; vitamin D prevents recurrence, it does not treat an attack.
- Recheck levels after several months to confirm correction.
Why it matters
It offers a cheap, safe way to prevent a condition that until now could only be treated episode by episode.
Don't overread it
This is a single two-centre trial in young adults (mean age 37) with deficiency; it does not show benefit in older patients or those with normal vitamin D.
The statistics, in plain English
A number needed to treat of 3.6 means treating about four deficient patients for two years prevents one recurrence, which is unusually effective. Single trials with effects this large are sometimes smaller when repeated, so confirmation elsewhere would strengthen it.
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