الفهرس 
Introduction and RationaleOnly 14 pages are availabe for public view
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Abstract
Vitamin D3 deficiency may cause disruption of the calcium concentration in the essential fluids, hair cells, and nervous tissue of the inner ear. Calcium ions regulate numerous and diverse aspects of cochlear and vestibular physiology (Ceriani and Mammano, 2012). In addition, vitamin D is well known for its osteoprotective effects. Significant clinical evidence indicates that vitamin D deficiency contributes to osteoporosis lead to demineralization and degenerative changes in otic capsule (Brookes, 1983, Zatonski et al., 2012).
In this study there was a strong correlation between vitamin D levels, and BPPV. Low serum levels of vitamin D3 were related to development of BPPV whereas very low levels were associated with recurrence of BPPV. The best cut off point for vitamin D serum level to differentiate between BPPV group and control group was found to be ≤ 13.1 ng/ml with sensitivity 65.33 and specificity 71.03% while the best cut off point to differentiate between recurrence and non recurrence BPPV cases was ≤ 10.7 ng/ml with sensitivity 74.07 and specificity of 54.17%.
Reduction in bone mass may be closely involved in the mechanism of BPPV recurrence as the incidence of BPPV with osteoporosis was 33.3%. While in recurrent BPPV it was 51.9%. The proportion of patients who suffered multiple recurrent episodes was higher among the patients with osteoporosis than among those with osteopenia.
Current study observed that low serum vitamin D and decreased bone mineral density especially in femur & forearm could be a potential risk for age-related hearing loss (Presbycusis) due to a similarity of femoral neck and radius bony structure to the petrous temporal bone (Khetarpal and Schuknecht, 1990). This study demonstrated inverse correlation between hearing thresholds and vitamin D deficiency, decreased femur and forearm bone mineral density.
This study puts forward the relation of otosclerosis and osteoporosis as the tendency for osteoporosis was more prevalent in otosclerosis patients with inverse correlation between bone mineral density obtained from femur neck, forearm and mean air conduction hearing thresholds In addition there was inverse correlation between femur neck bone mineral density and bone conduction hearing thresholds indicate the relation of osteoporosis and otosclerosis.
Current study did not show any significant correlation between vitamin D serum levels or the decrease in bone mineral density with c-VEMP parameters including latencies and amplitude. Moreover, this work failed to report any association of vitamin D deficiency with Meniere’s disease occurrence and its degree of hearing loss.