{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T10:02:45Z","timestamp":1785232965903,"version":"3.55.0"},"reference-count":21,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ann Otol Rhinol Laryngol"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To determine whether cholecalciferol supplementation reduces recurrence rates in patients with benign paroxysmal positional vertigo (BPPV) and concurrent vitamin D deficiency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study design:<\/jats:title>\n                    <jats:p>Prospective, randomized, double-blind, placebo-controlled trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>Two tertiary otolaryngology centers in Baghdad, Iraq (Al-Kafaat Hospital ENT outpatient clinic and Al-Dora Hospital ENT outpatient clinic).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>One hundred sixty adults with confirmed idiopathic BPPV and serum 25-hydroxyvitamin D\u2009&lt;\u200920\u2009ng\/mL were randomized 1:1 to receive cholecalciferol 10\u2009000\u2009IU weekly or matched placebo for 24\u2009months. Primary outcome was BPPV recurrence (cumulative incidence, time-to-first recurrence) at 6, 12, 18, and 24\u2009months. Secondary outcomes included vitamin D concentrations, DHI scores, per-participant recurrence frequency, and safety parameters. Full intention-to-treat analysis; missing data handled by multiple imputation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Baseline characteristics were balanced between groups (mean age 36.8\u2009\u00b1\u20097.2\u2009years). Cholecalciferol significantly elevated serum 25-hydroxyvitamin D concentrations at all timepoints (24\u2009months: 24.8\u2009\u00b1\u20093.2 vs 9.8\u2009\u00b1\u20093.6\u2009ng\/mL,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001). BPPV recurrence was significantly reduced with cholecalciferol versus placebo at 6\u2009months (15.0% vs 35.0%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.004), 12\u2009months (22.5% vs 48.8%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001), 18\u2009months (25.0% vs 52.5%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001), and 24\u2009months (27.5% vs 55.0%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001), representing a 50% relative risk reduction. Number needed to treat was 3.6. No hypercalcemic episodes occurred. Treatment adherence exceeded 94% in both groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Cholecalciferol supplementation provides sustained, clinically meaningful reduction in BPPV recurrence among vitamin D-deficient patients over 24\u2009months with excellent safety profile. Routine vitamin D assessment and targeted supplementation may be considered in vitamin D-deficient BPPV patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00034894261449743","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T04:14:36Z","timestamp":1778213676000},"page":"720-727","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Vitamin D Supplementation for Preventing Recurrent Benign Paroxysmal Positional Vertigo: A Randomized Clinical Study"],"prefix":"10.1177","volume":"135","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-7610-7952","authenticated-orcid":false,"given":"Hussein Ali","family":"Tawfeeq","sequence":"first","affiliation":[{"name":"Department of Anesthesia Techniques, Al-Farahidi University, Baghdad, Iraq"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0133-1087","authenticated-orcid":false,"given":"Mustafa Adnan","family":"Zaidan","sequence":"additional","affiliation":[{"name":"Department of Anesthesia Techniques, Al-Farahidi University, Baghdad, Iraq"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3585-1136","authenticated-orcid":false,"given":"Ali Kamal","family":"Ghanim","sequence":"additional","affiliation":[{"name":"Al-Karkh Health Directorate, Ministry of Health, Baghdad, Iraq"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"key":"e_1_3_3_2_2","article-title":"Clinical practice guideline: benign paroxysmal positional vertigo (update)","volume":"156","author":"Bhattacharyya N","year":"2019","unstructured":"Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T, et al. Clinical practice guideline: benign paroxysmal positional vertigo (update). Otolaryngol Head Neck Surg. 2019;156(3_suppl):S1-S47.","journal-title":"Otolaryngol Head Neck Surg"},{"key":"e_1_3_3_3_2","article-title":"Assembly of the otoconia: protein-protein interactions, posttranslational modifications, and associated disorders","volume":"394","author":"Lundberg YW","year":"2020","unstructured":"Lundberg YW, Zhao X, Yamoah EN. Assembly of the otoconia: protein-protein interactions, posttranslational modifications, and associated disorders. Hear Res. 2020;394:107918.","journal-title":"Hear Res"},{"issue":"6","key":"e_1_3_3_4_2","first-page":"475","article-title":"Benign paroxysmal positional vertigo: diagnostic criteria consensus document of the committee for the classification of vestibular disorders of the B\u00e1r\u00e1ny Society","volume":"32","author":"von Brevern M","year":"2022","unstructured":"von Brevern M, Bertholon P, Brandt T, Fife T, Imai T, Nuti D, et al. Benign paroxysmal positional vertigo: diagnostic criteria consensus document of the committee for the classification of vestibular disorders of the B\u00e1r\u00e1ny Society. J Vestib Res. 2022;32(6):475-485.","journal-title":"J Vestib Res"},{"issue":"4","key":"e_1_3_3_5_2","first-page":"1456","article-title":"Increasing prevalence of BPPV in vitamin D deficient populations: a 10-year epidemiological study","volume":"12","author":"Kim SY","year":"2023","unstructured":"Kim SY, Lee JH, Park MS, Han JH, Kang YS. Increasing prevalence of BPPV in vitamin D deficient populations: a 10-year epidemiological study. J Clin Med. 2023;12(4):1456.","journal-title":"J Clin Med"},{"issue":"17","key":"e_1_3_3_6_2","article-title":"Diagnosis and management of benign paroxysmal positional vertigo (BPPV)","volume":"192","author":"Parnes LS","year":"2020","unstructured":"Parnes LS, Agrawal SK, Atlas J. Diagnosis and management of benign paroxysmal positional vertigo (BPPV). CMAJ. 2020;192(17):E461-E469.","journal-title":"CMAJ"},{"issue":"3","key":"e_1_3_3_7_2","first-page":"687","article-title":"Long-term recurrence patterns in benign paroxysmal positional vertigo: a 15-year cohort study","volume":"170","author":"Thompson K","year":"2024","unstructured":"Thompson K, Wilson CL, Davies RA, Mitchell S, Carter B. Long-term recurrence patterns in benign paroxysmal positional vertigo: a 15-year cohort study. Otolaryngol Head Neck Surg. 2024;170(3):687-695.","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"8","key":"e_1_3_3_8_2","first-page":"3721","article-title":"Vitamin D deficiency and BPPV recurrence: systematic review and meta-analysis of observational studies","volume":"280","author":"Martinez-Lopez M","year":"2023","unstructured":"Martinez-Lopez M, Garcia-Puente N, Sanchez-Blanco C, Rodriguez A, Hernandez R. Vitamin D deficiency and BPPV recurrence: systematic review and meta-analysis of observational studies. Eur Arch Otorhinolaryngol. 2023;280(8):3721-3732.","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.3390\/nu16050672"},{"issue":"2","key":"e_1_3_3_10_2","first-page":"128","article-title":"Methodological quality assessment of vitamin D supplementation trials in BPPV: a systematic review","volume":"16","author":"Rodriguez-Martinez A","year":"2023","unstructured":"Rodriguez-Martinez A, Jimenez-Sanchez L, Torres-Garcia M. Methodological quality assessment of vitamin D supplementation trials in BPPV: a systematic review. J Evid Based Med. 2023;16(2):128-141.","journal-title":"J Evid Based Med"},{"issue":"1","key":"e_1_3_3_11_2","first-page":"45","article-title":"Sample size adequacy in BPPV intervention studies: a methodological review and recommendations","volume":"49","author":"Harrison PM","year":"2024","unstructured":"Harrison PM, Scott-Brown M, Li X, Wong T, Patel A. Sample size adequacy in BPPV intervention studies: a methodological review and recommendations. Clin Otolaryngol. 2024;49(1):45-53.","journal-title":"Clin Otolaryngol"},{"issue":"4","key":"e_1_3_3_12_2","first-page":"87","article-title":"Vitamin D receptor polymorphisms influence treatment response in BPPV patients: a pharmacogenomic study","volume":"23","author":"Nakamura S","year":"2023","unstructured":"Nakamura S, Watanabe Y, Suzuki N, Kobayashi T, Fujimoto K. Vitamin D receptor polymorphisms influence treatment response in BPPV patients: a pharmacogenomic study. Pharmacogenomics J. 2023;23(4):87-94.","journal-title":"Pharmacogenomics J"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.11613\/BM.2021.010502"},{"issue":"2","key":"e_1_3_3_14_2","first-page":"289","article-title":"Sustained vitamin D supplementation effects in BPPV prevention: 24-month multicenter trial results","volume":"57","author":"Anderson JM","year":"2024","unstructured":"Anderson JM, Davis KL, Murphy TJ, Brown R, Lewis P. Sustained vitamin D supplementation effects in BPPV prevention: 24-month multicenter trial results. Otolaryngol Clin North Am. 2024;57(2):289-302.","journal-title":"Otolaryngol Clin North Am"},{"issue":"8","key":"e_1_3_3_15_2","first-page":"892","article-title":"Clinical implementation of vitamin D screening in BPPV management: real-world effectiveness study","volume":"137","author":"Williams RB","year":"2023","unstructured":"Williams RB, Jackson PL, Foster ME, Clark J, Patel H. 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