Benign Paroxysmal Positional Vertigo in Pregnancy

Introduction

Benign paroxysmal positional vertigo (BPPV) is a clinical entity characterized by acute, brief, paroxysmal attacks of rotational vertigo induced by head position changes. It is the most common peripheral vestibular pathology and is seen more frequently in women than men with a ratio of 2:1 V体育官网入口. In BPPV, degenerative debris dislocated from the utricle into the semicircular canals increase the density of the cupula (1). This may occur either when the deposits abnormally attach to the cupula (cupulolithiasis) or when the dense particles freely move in the endolymphatic fluid in the semicircular canals (canalolithiasis) (2).

A diagnosis of posterior semicircular canal BPPV is confirmed with a transient, upbeating, torsional nystagmus with the eyes beating toward the underlying ear when the patient is rapidly positioned into the lateral head-hanging position (Dix-Hallpike maneuver) (2) VSports在线直播. The most commonly used canalith-repositioning maneuver is the Epley maneuver (2–4).

The etiology may be idiopathic (50%–70% of all cases) or secondary to infections, migraine, Meniere’s disease, otologic/nonotologic surgery, prolonged bed rest, trauma, vascular, and metabolic pathologies, following magnetic resonance imaging (1–3, 5, 6). Giacomini et al V体育2025版. (1) discussed 10 cases of BPPV secondary to oral contraceptive use. They hypothesized that hormonal disorders in women may trigger some BPPV forms, and the increased prevalence in women compared with men could be associated with these hormonal alterations.

We present four pregnant women diagnosed with BPPV during their gestational periods. To our knowledge, very limited data are available in the English literature considering this co-occurrence. Three cases of pregnant women with BPPV were mentioned in a Chinese Journal; thus, this article could not be reviewed. We hope to inspire further clinical studies regarding this co-occurrence with our multiple case reports. Using this technique, we aimed to review the literature on BPPV etiology and discuss the possible pathophysiological factors contributing to BPPV in pregnancy VSports.

Case Presentations

V体育ios版 - Discussion

Benign paroxysmal positional vertigo has various etiologies, but hormonal abnormalities or hormonal changes as predisposing factors are not clarified sufficiently in the literature. Hormonal alterations during menstrual cycle, gestation, and menopause induce various homeostatic, metabolic effects. Various theories regarding estrogen effects have been proposed. Estrogen receptors were found in the inner ears of normal mice (7). They have been detected, especially in the spiral ganglion and stria vascularis, which are important in hearing transmission and inner ear homeostasis (8). Estrogen alterations are considered to either impair endolymphatic fluid electrolyte concentration, leading to degeneration of otoconial fibers, or induce endolymphatic pH liabilities, causing otoconial degeneration (1). Estrogen is believed to affect endolymph ionic and anionic homeostasis by regulating ion and anion channels (9, 10). Furthermore, it is assumed that estrogen induces vascular supply to the macula and otoconia due to varied glucose and lipid metabolism (1).

Kilicdag et al. (11) studied the effects of estrogen therapy on hearing in postmenopausal women. They found that both estrogen and hormone therapy (combined estrogen and progesterone) groups had better hearing levels than the control groups. They also found that the estrogen therapy group had significantly better hearing thresholds at low frequencies than the hormone therapy group. They postulated that, unlike estrogen, progesterone may have negative effects on low-frequency hearing levels.

Ogun et al. (12) investigated the effects of menopause in a large cohort of patients diagnosed with BPPV. Their study showed that 48.1% of female patients with BPPV experienced their first BPPV attack after menopause. The increased BPPV prevalence with age has previously been well documented and this is higher in females than in males. They also suggested that low and fluctuating estrogen levels may lead to otoconial degeneration.

Estrogen and progesterone levels show variations during the time course of pregnancy. The hormonal impacts on the physiology of the inner ear in each trimester of gestation cycle remain unclear.

In our study, three cases were diagnosed during the late trimesters, when estrogen levels are relatively low and progesterone levels are high. This result corresponds to the data in the literature regarding the role of estrogen in inner ear pathologies. Additionally, hormonal instabilities or alterations, as a cause for BPPV is reconsidered once again with this group of patients. Prolonged bed rest may be another cause for BPPV in pregnant women. Three of our patients were diagnosed during the late gestational weeks (second and third cases had initial symptoms during the second trimester, but both mentioned that the severity increased in proportion with gestational week), when sleeping and daily activities were restricted. Furthermore, pregnant women are usually advised to sleep on their left sides, which may be another risk factor for BPPV. However, all four cases were maintaining a normal gestational period. They had no risk factors that would require additional prolonged bed stay.

Recently, there were reports that calcium and vitamin D metabolism disorders are risk factors for BPPV. Calcium and vitamin D metabolism is usually affected in pregnancy, especially in the late trimesters due to the rapid growth of the fetus. This may be another risk factor for pregnant women suffering from BPPV (13). However, according to the guidelines of American College of Obstetricians and Gynecologists, vitamin D supplementation should only be recommended to pregnant women at an increased risk (14). Hence, routine prenatal screening of vitamin D and serum calcium levels were not conducted by the obstetricians at our medical center. Additionally, there is no consensus on the optimal level and the upper limit of the supplemental doses of these parameters in pregnancy (14). Due to these recent findings of the role of vitamin D metabolism in BPPV, serum vitamin D and calcium levels were investigated in the fourth case, and vitamin D level was found to be low. The patient was referred to her gynecologist for supplementation therapy. This was the only case with recurrent BPPV. Low vitamin D levels may have induced BPPV attacks in this patient; however, further studies in larger series are required to evaluate this association.

"V体育官网入口" Conclusion

Although the association between BPPV and gestation remains uncertain, to the best of our knowledge, there is very limited data in the English literature on this subject.

Neurotologists and gynecologists should be aware of pregnant women with vertigo. To improve the quality of life quality during gestation, clinicians should consider this pathology in their differential diagnosis, which will help avoid vertigo-related undesirable conditions that may compromise both maternal and fetal status.

Is pregnancy an independent risk factor of BPPV, or do the numbers of metabolic, functional, or emotional changes during pregnancy serve as separate risk factors in this pathology? The authors hope this case series will increase the attempts for further clinical trials providing data for this question.