Salivary [alpha]-amylase levels in vertigo: Can it be an autonomic dysfunction?

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From: Ear, Nose and Throat Journal(Vol. 97, Issue 9)
Publisher: Sage Publications, Inc.
Document Type: Report
Length: 3,301 words
Lexile Measure: 1490L

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We aim to demonstrate possible autonomic dysfunction based on salivary [alpha]-amylase measurements during and after the vertigo attacks associated with Meniere disease (MD) and benign paroxysmal positional vertigo (BPPV). Patients admitted to the emergency room with a diagnosis of vertigo attacks caused by either MD (n = 15) or BPPV (n = 9) constituted the study groups. The control group (n = 10) consisted of volunteer patients admitted to the emergency department with minor soft-tissue trauma. The first saliva samples were obtained immediately during the attacks and the second and third samples were obtained on the third and fifteenth days of the attack, respectively. In the controls, the first sample was obtained after admission to the hospital and the second sample was obtained on the third day. Salivary [alpha]-amylase levels were evaluated. The difference between salivary [alpha]-amylase levels in patients with MD and BPPV was not significant. The amylase value measured early after the BPPV attack was significantly lower than that of the controls (p = 0.008). Although not significant, an undulating pattern of salivary [alpha]-amylase levels was observed with both diseases. An autonomic imbalance could be partly demonstrated by salivary [alpha]-amylase measurement early after the attack in patients with BPPV. Therefore, amylase may be a promising marker that is worth further investigation.


Vertigo is a common symptom encountered in the emergency department (ED). It adversely affects many quality-of-life aspects. Benign paroxysmal positional vertigo (BPPV) and, to a lesser extent, Meniere disease (MD) account for a considerable number of patients seeking medical help in EDs.

BPPV is characterized by brief, recurrent attacks of vertigo triggered by changes in head position. The attacks may be followed by residual dizziness in some patients. With the use of canalith repositioning maneuvers, management of BPPV is usually easy for most patients. (1) MD is a disease of the peripheral vestibular system characterized by repetitive attacks of vertigo, tinnitus, and low-frequency hearing loss. Although many factors such as genetics, allergy, autoimmunity, and stress are presumed to have a role in the etiology of MD, the exact pathophysiologic changes have not been elucidated. (2,3)

The hypothalamic pituitary adrenal axis, autonomic nervous system, and immune system are interrelated components of the stress response. The role of stress has been documented in inner ear diseases in many studies. (4,5) Studies showed the vestibular system and the autonomic system to be closely related since vestibular activity influences the cardiovascular system. Central anatomic connections between vestibular nuclei and the autonomic pathways have been identified. (6) In addition, stress hormones have been reported to modify inner ear functions such as threshold shifts. (7)

Horner reported prolactin to have a role in MD by its effect on osmoregulatory mechanisms.6 Together with growth hormone, prolactin is now considered a major stress-induced hormone. (8) Yildiz et al showed a marked asymmetric sympathetic hypofunction in the area of the postauricular region of the involved ear in patients with MD. (9) The hypofunction was demonstrated with the use of sympathetic skin responses in the...

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Gale Document Number: GALE|A558921694