BACKGROUND: The aim of this study is to verify if (1) there is a link between hypovitaminosis D and benign paroxysmal positional vertigo, (2) the number of benign paroxysmal positional vertigo relapses decreases after vitamin D supplementation; and (3) benign paroxysmal positional vertigo response to physical therapy improves after hypovitaminosis D correction. METHODS: We enrolled 26 patients with benign paroxysmal positional vertigo and 24 subjects, who never suffered from vertigo, as a control group. All benign paroxysmal positional vertigo patients underwent physical therapy, once a week, until benign paroxysmal positional vertigo resolution. All participants were subjected to a dosage of serum 25(OH) vitamin D. In patients with hypovitaminosis D, we prescribed cholecalciferol. After 3 months of therapy, all patients were asked to undergo a second dosage of serum 25(OH) vitamin D. For each patient, we counted the number of maneuvers required to resolve each episode of benign paroxysmal positional vertigo before and after vitamin D supplementation. RESULTS: Our results suggest that (1) there is a relationship between vitamin D deficiency and the onset of BPPV and (2) hypovitaminosis correction is able to reduce both the number of patients relapsing and the number of relapses per patient. CONCLUSIONS: We have not found a significant effect of vitamin D supplementation as regards the responsivity of benign paroxysmal positional vertigo to physical therapy. Cite this article as: Pecci R, Mandalà M, Marcari A, et al. Vitamin D insufficiency/deficiency in patients with recurrent benign paroxysmal positional vertigo. J Int Adv Otol. 2022;18(2):158-166.

A structured four-step bedside algorithm, named SponTAneous Nystagmus, Direction, head Impulse test, standiNG (STANDING), has been proposed to differentiate central from peripheral acute vestibulopathy in the Emergency Department (ED). We aimed to evaluate the effective application of STANDING in the management of vertigo in the ED and to define its role in deciding the patient's pathway after discharge. We retrospectively analysed data from 131 consecutive patients (65% female, mean age 56) undergoing ED visits for a vertigo complaint between April and May 2016. Our study showed that the STANDING algorithm is under-used, being performed only in the 18% of patients. The positivity of the STANDING did not influence the choice of the following pathway (e.g. outpatient fast track or discharge). Moreover, a small percentage of patients had a non-audiological diagnosis (mainly presyncope), for which no defined pathways were yet foreseen. Our study emphasized the need for continuous updating with appropriate training courses and the importance of a multidisciplinary assessment of vertigo in the ED.

Objective: Cochlear receptors are sensitive to vibratory stimuli. Based on this sensibility, bone-anchored hearing aids have been introduced to correct unilateral or bilateral conductive or mixed hearing loss and unilateral deafness. The vestibular system is also sensitive to the vibratory stimulus and this type of response is used in clinics to test its functionality. Being aware of this double separated sensibility, we wondered whether bone vibration, which activates the acoustic receptors of patients with bone conduction aids, can also influence the functionality of the vestibular system. Methods: To this end, we recruited 12 patients with a bone-anchored hearing aid and evaluated their vestibular function with and without an activated vibratory acoustic device. Results: Our results show that the vibratory stimulus delivered by the bone conduction aid also reaches and stimulates the vestibular receptors; this stimulation is evidenced by the appearance or modification of some nystagmus findings during bedside vestibular testing. Despite this, none of these patients complained of dizziness or vertigo during prosthesis use. Nystagmus that appeared or changed during acoustic vibratory stimulation through the prosthesis was almost all predominantly horizontal, unidirectional with respect to gaze or body position, inhibited by fixation, and most often consistent with vestibular function tests indicating peripheral vestibular damage. Conclusions: The findings of sound-evoked nystagmus seem to indicate peripheral rather than central vestibular activation. The occurrence of some predominantly horizontal and high-frequency induced nystagmus seems to attribute the response mainly to the utricle and lateral semicircular canal.

Objective: To present the initial clinical experience with tympano-stapedotomy using the new semisynthetic TORP (NSSTORP) in patients with stapes otosclerosis associated with malleus fixation and in stapedotomy revision with unusable incus, as a less invasive alternative to malleo-stapedotomy. Methods: Between June 2024 and June 2025, 6 patients (5 females, one male; mean age, 42.1 y) underwent tympano-stapedotomy at 2 tertiary referral centers: 3 primary cases with stapes otosclerosis and malleus fixation (Avellino) and 3 revision cases with incus necrosis (Siena). All procedures were performed under local anesthesia using a surgical microscope, and a 6.5-mm-long NSSTORP was implanted in every case. Pre- and postoperative audiometric evaluation included air conduction, bone conduction, and air-bone gap (ABG) at 0.5, 1, 2, and 3 kHz. The main outcome measure was postoperative ABG ≤20 dB. Follow-up ranged from 3 to 10 months (mean, 7.2 mo). Results: No patient experienced worsening of bone conduction, dizziness, or tinnitus. The pure-tone average improved from a preoperative mean of 48.9 dB (SD = 6.9) to a postoperative mean of 32.1 dB (SD = 8.4), for a mean hearing gain of 16.8 dB (SD = 4.5). The mean ABG decreased from 25.5 dB (SD = 3.8) to 11.4 dB (SD = 3.5), representing a mean improvement of 14.1 dB (SD = 3.0). A postoperative ABG of less than 20 dB was achieved in 100% of the cases. Conclusion: Tympano-stapedotomy with the NSSTORP avoids the technically demanding steps of malleo-stapedotomy and eliminates vestibular penetration.

Background: Vertigo and dizziness are common neurological complaints in childhood, and increasing evidence suggests that a substantial proportion of recurrent vestibular symptoms may represent early manifestations of migraine-related disorders. However, current diagnostic criteria for pediatric vestibular migraine may underestimate migraine involvement in prepubertal children, in whom vestibular and autonomic symptoms often precede or occur independently of headache. Objectives: To reassess a large pediatric cohort of children with recurrent vestibular symptoms using a developmental migraine-spectrum model integrating vestibular manifestations, migraine precursors, and susceptibility markers. Methods: This retrospective multicenter study analyzed 146 children aged 3-12 years evaluated for recurrent vestibular symptoms between 1995 and 2022 at two Italian tertiary referral centers. All patients were initially classified according to the 2021 Bárány Society and International Headache Society criteria. A secondary structured evaluation assessed family history of migraine, headache characteristics, vestibular phenotype, benign paroxysmal torticollis, extra-vestibular migraine precursors (cyclic vomiting, recurrent abdominal pain, and related episodic syndromes), and migraine susceptibility markers including motion sickness and sensory hypersensitivity. Results: Of the 146 children, 144 fulfilled the Bárány Society criteria for Recurrent Vertigo of Childhood, whereas two presented with isolated benign paroxysmal torticollis, interpreted according to Pagnini’s model as a migraine-related manifestation of the descending vestibulo-cervical pathway [21]. None fulfilled the criteria for Vestibular Migraine of Childhood or probable Vestibular Migraine of Childhood. Headache was present in only 15.8% of patients and was generally mild to moderate. Most children exhibited recurrent isolated vestibular episodes with frequent autonomic symptoms, while a subgroup presented with benign paroxysmal torticollis. Motion sickness and sensory hypersensitivity were highly prevalent, and many patients showed additional developmental migraine precursors, including abdominal pain, cyclic vomiting, limb pain, and infant colic. Vestibular symptoms frequently preceded headache onset, supporting the hypothesis that migraine susceptibility may manifest predominantly through vestibular and autonomic pathways during childhood. Conclusions: Pediatric recurrent vertigo should be considered within a broader developmental migraine spectrum rather than as an isolated vestibular disorder. Current diagnostic criteria may lack sensitivity in prepubertal populations by emphasizing headache-related features. Integrating vestibular symptoms, developmental migraine equivalents, and susceptibility markers may improve early recognition of migraine-related vestibulopathy and provide a biologically plausible model for the developmental evolution of migraine-related vestibulopathy across childhood and adolescence.

Background: Complaints of vertigo and dizziness are frequently encountered in childhood and may coexist with migraine-associated features. The present study reassessed a historical pediatric cohort within an expanded phenotypic framework. Methods: This retrospective multicenter descriptive study analyzed 146 children aged 3–12 years evaluated for recurrent vestibular symptoms between 1995 and 2022 at two Italian tertiary neuro-otological referral centers. Clinical history and neuro-otological examination represented the common diagnostic foundation, while age-appropriate audiological evaluation was performed in virtually all children and additional vestibular or imaging investigations were clinically selective. Results: Of the 146 children, 144 fulfilled the 2021 Bárány Society criteria for Recurrent Vertigo of Childhood (RVC), whereas two presented with isolated benign paroxysmal torticollis. None fulfilled the criteria for Vestibular Migraine of Childhood or probable Vestibular Migraine of Childhood. Headache was reported in 15.8% of patients, whereas motion sensitivity, sensory hypersensitivity, autonomic symptoms, and additional migraine-associated developmental syndromes were frequently observed. Conclusions: In this selected tertiary cohort, the clustering of migraine-associated features was compatible with a developmental migraine-related vestibular spectrum. These phenotypic associations do not demonstrate longitudinal disease evolution, and prospective longitudinal studies are required.