Otolith Dysfunction in Persons with Both Diabetes and Benign Paroxysmal Positional Vertigo

Objective: Vestibular dysfunction is a well-recognized complication of type 2 diabetes (DM) that may contribute to increased fall risk. The prevalence of benign paroxysmal positional vertigo (BPPV) is higher in people with DM. The impact of DM on the otolith organs of the vestibular system in people with BPPV is unknown. The purpose of this study was to analyze otolith function using vestibular-evoked myogenic potential (VEMP) tests in people with DM and concurrent BPPV (BPPV + DM), and to examine the relationships between VEMP variables and diabetes-related variables. Study Design: Prospective, cross-sectional study. Setting: Tertiary academic medical center. Subjects and Methods: Participants 40 to 65 years were recruited in four groups: controls (n = 20), people with DM (n = 19), BPPV (n = 18), and BPPV + DM (n = 14). Saccule and utricle function were examined using cervical VEMP (cVEMP) and ocular VEMP (oVEMP), respectively. Diabetes-related variables such as HbA1c, duration of diabetes, and presence of sensory impairment due to diabetes were collected. Results: The frequency of abnormal cVEMP responses was higher in the DM (p = 0.005), BPPV (p = 0.003), and BPPV + DM (p <0.001) groups compared with controls. In the participants with diabetes, higher HbA1c levels were correlated with prolonged P1 (p = 0.03) and N1 latencies (p = 0.03). The frequency of abnormal oVEMP responses was not different between groups (p = 0.2). Conclusion: Although BPPV and DM may independently affect utricle and saccule function, they do not seem to have a distinct cumulative effect.