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Murphy CE, Roberts RA, Picou EM, Jacobson GP, Green AP. Probabilities of Isolated and Co-Occurring Vestibular Disorder Symptom Clusters Identified Using the Dizziness Symptom Profile. Ear Hear 2024; 45:878-883. [PMID: 38287481 DOI: 10.1097/aud.0000000000001482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
OBJECTIVES Dizziness is among the most common reasons people seek medical care. There are data indicating patients with dizziness, unsteadiness, or vertigo may have multiple underlying vestibular disorders simultaneously contributing to the overall symptoms. Greater awareness of the probability that a patient will present with symptoms of co-occurring vestibular disorders has the potential to improve assessment and management, which could reduce healthcare costs and improve patient quality of life. The purpose of the current investigation was to determine the probabilities that a patient presenting to a clinic for vestibular function testing has symptoms of an isolated vestibular disorder or co-occurring vestibular disorders. DESIGN All patients who are seen for vestibular function testing in our center complete the dizziness symptom profile, a validated self-report measure, before evaluation with the clinician. For this retrospective study, patient scores on the dizziness symptom profile, patient age, and patient gender were extracted from the medical record. The dizziness symptom profile includes symptom clusters specific to six disorders that cause vestibular symptoms, specifically: benign paroxysmal positional vertigo, vestibular migraine, vestibular neuritis, superior canal dehiscence, Meniere disease, and persistent postural perceptual dizziness. For the present study, data were collected from 617 participants (mean age = 56 years, 376 women, and 241 men) presenting with complaints of vertigo, dizziness, or imbalance. Patients were evaluated in a tertiary care dizziness specialty clinic from October 2020 to October 2021. Self-report data were analyzed using a Bayesian framework to determine the probabilities of reporting symptom clusters specific to an isolated disorder and co-occurring vestibular disorders. RESULTS There was a 42% probability of a participant reporting symptoms that were not consistent with any of the six vestibular disorders represented in the dizziness symptom profile. Participants were nearly as likely to report symptom clusters of co-occurring disorders (28%) as they were to report symptom clusters of an isolated disorder (30%). When in isolation, participants were most likely to report symptom clusters consistent with benign paroxysmal positional vertigo and vestibular migraine, with estimated probabilities of 12% and 10%, respectively. The combination of co-occurring disorders with the highest probability was benign paroxysmal positional vertigo + vestibular migraine (~5%). Probabilities decreased as number of symptom clusters on the dizziness symptom profile increased. The probability of endorsing vestibular migraine increased with the number of symptom clusters reported. CONCLUSIONS Many patients reported symptoms of more than one vestibular disorder, suggesting their symptoms were not sufficiently captured by the symptom clusters used to summarize any single vestibular disorder covered by the dizziness symptom profile. Our results indicate that probability of symptom clusters indicated by the dizziness symptom profile is comparable to prior published work on the prevalence of vestibular disorders. These findings support use of this tool by clinicians to assist with identification of symptom clusters consistent with isolated and co-occurring vestibular disorders.
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Affiliation(s)
- Claire E Murphy
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Richard A Roberts
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Erin M Picou
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Gary P Jacobson
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrea P Green
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Current Position: Sonova USA, Inc., Aurora, Illinois, USA
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Reyhani Y, Taheri A, Tavanai E, Rahimi V, Hasanalifard M, Jalaie S. Comparison of the Degree of Handicap Between Different Types of Vestibular Disorders. Indian J Otolaryngol Head Neck Surg 2024; 76:2635-2645. [PMID: 38883464 PMCID: PMC11169380 DOI: 10.1007/s12070-023-04315-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/21/2023] [Indexed: 06/18/2024] Open
Abstract
Vestibular disorders have had a disabling effect because of the symptoms they cause. The aim of this study was to evaluate the degree of disability associated with vertigo in patients with different vestibular disorders using a handicap questionnaire and to investigate the possible relationship between some factors with different types of vestibular disorders and vertigo-related handicap scores. 462 subjects aged 12-90 years old with symptoms of vertigo, dizziness, or imbalance were recruited from several public and private centers. After taking the medical history, the patients fillled out the Vertigo Handicap Questionnaire (VHQ). There was a significant difference between the VHQ mean scores of vestibular disorders (p = 0.002). There was also a significant relationship between the male sex and BPPV and blood supply problems, between women with endolymphatic hydrops, vestibular neuritis, VM, CNS disorders, concomitant BPPV, and hydrops, between vestibular disorders and various ranges of hearing. BPPV, neuritis, VM, were also significantly correlated with blood pressure, concomitant BPPV and hydrops, with diabetes and hydrops, and concomitant BPPV and hydrops were significantly correlated with cholesterol. The coexistence of various vestibular disorders may cause additional handicaps and should be considered. Some comorbidities may also affect the degree of handicap, although their effects may not be the same. Various factors in addition to the type of vestibular disorder, such as personality, culture, education level, income, and strategies for coping with the disease, may also determine the level of patient-reported vertigo handicap.
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Affiliation(s)
- Yousef Reyhani
- New Hearing Technologies Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Abolfazl Taheri
- New Hearing Technologies Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Elham Tavanai
- Department of Audiology, Faculty of Rehabilitation, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Vida Rahimi
- Department of Audiology, Faculty of Rehabilitation, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mahdieh Hasanalifard
- New Hearing Technologies Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Shohreh Jalaie
- School of Rehabilitation Sciences, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Murphy BL, Fischer JL, Tolisano AM, Navarro AI, Trinh L, Abuzeid WM, Humphreys IM, Akbar NA, Shah S, Schneider JS, Riley CA, McCoul ED. How Do Patients and Otolaryngologists Define Dizziness? Ann Otol Rhinol Laryngol 2024; 133:512-518. [PMID: 38375799 DOI: 10.1177/00034894241233949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
OBJECTIVE To assess for differences in how patients and otolaryngologists define the term dizziness. METHODS Between June 2020 and December 2022, otolaryngology clinicians and consecutive patients at 5 academic otolaryngology institutions across the United States were asked to define the term "dizziness" by completing a semantics-based questionnaire containing 20 common descriptors of the term within 5 symptom domains (imbalance-related, lightheadedness-related, motion-related, vision-related, and pain-related). The primary outcome was differences between patient and clinician perceptions of dizzy-related symptoms. Secondary outcomes included differences among patient populations by geographic location. RESULTS Responses were obtained from 271 patients and 31 otolaryngologists. Patients and otolaryngologists selected 7.7 ± 3.5 and 7.1 ± 4.3 symptoms, respectively. Most patients (266, 98.2%) selected from more than 1 domain and 17 (6.3%) patients identified symptoms from all 5 domains. Patients and clinicians were equally likely to define dizziness using terms from the imbalance (difference, -2.3%; 95% CI, -13.2%, 8.6%), lightheadedness (-14.1%; -29.2%, 1.0%), and motion-related (9.4; -0.3, 19.1) domains. Patients were more likely to include terms from the vision-related (23.6%; 10.5, 36.8) and pain-related (18.2%; 10.3%, 26.1%) domains. There were minor variations in how patients defined dizziness based on geographic location. CONCLUSIONS Patients and otolaryngologists commonly described dizziness using symptoms related to imbalance, lightheadedness, and motion. Patients were more likely to use vision or pain-related terms. Understanding of these semantic differences may enable more effective patient-clinician communication.
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Affiliation(s)
- Brianna L Murphy
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Jakob L Fischer
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Anthony M Tolisano
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Alvaro I Navarro
- Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, LA, USA
| | - Lily Trinh
- Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, LA, USA
| | - Waleed M Abuzeid
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA
| | - Ian M Humphreys
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA
| | - Nadeem A Akbar
- Division of Rhinology and Skull Base Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sharan Shah
- Division of Rhinology and Skull Base Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - John S Schneider
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Charles A Riley
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Edward D McCoul
- Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, LA, USA
- Department of Otorhinolaryngology and Communication Sciences, Ochsner Clinic Foundation, New Orleans, LA, USA
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Ratzan EM, Lee J, Madison MA, Zhu H, Zhou W, Géléoc GSG, Holt JR. TMC function, dysfunction, and restoration in mouse vestibular organs. Front Neurol 2024; 15:1356614. [PMID: 38638308 PMCID: PMC11024474 DOI: 10.3389/fneur.2024.1356614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
Tmc1 and Tmc2 are essential pore-forming subunits of mechanosensory transduction channels localized to the tips of stereovilli in auditory and vestibular hair cells of the inner ear. To investigate expression and function of Tmc1 and Tmc2 in vestibular organs, we used quantitative polymerase chain reaction (qPCR), fluorescence in situ hybridization - hairpin chain reaction (FISH-HCR), immunostaining, FM1-43 uptake and we measured vestibular evoked potentials (VsEPs) and vestibular ocular reflexes (VORs). We found that Tmc1 and Tmc2 showed dynamic developmental changes, differences in regional expression patterns, and overall expression levels which differed between the utricle and saccule. These underlying changes contributed to unanticipated phenotypic loss of VsEPs and VORs in Tmc1 KO mice. In contrast, Tmc2 KO mice retained VsEPs despite the loss of the calcium buffering protein calretinin, a characteristic biomarker of mature striolar calyx-only afferents. Lastly, we found that neonatal Tmc1 gene replacement therapy is sufficient to restore VsEP in Tmc1 KO mice for up to six months post-injection.
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Affiliation(s)
- Evan M. Ratzan
- Department of Otolaryngology, F.M. Kirby Neurobiology Center, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States
| | - John Lee
- Department of Otolaryngology, F.M. Kirby Neurobiology Center, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Margot A. Madison
- Department of Otolaryngology, F.M. Kirby Neurobiology Center, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Hong Zhu
- Department of Otolaryngology - Head and Neck Surgery, University of Mississippi Medical Center, Jackson, MS, United States
| | - Wu Zhou
- Department of Otolaryngology - Head and Neck Surgery, University of Mississippi Medical Center, Jackson, MS, United States
| | - Gwenaëlle S. G. Géléoc
- Department of Otolaryngology, F.M. Kirby Neurobiology Center, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Jeffrey R. Holt
- Department of Otolaryngology, F.M. Kirby Neurobiology Center, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States
- Department of Neurology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States
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5
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Wellons RD, Duhe SE, MacDowell SG, Oxborough S, Kc M. Investigating health disparities in vestibular rehabilitation. J Vestib Res 2024; 34:205-214. [PMID: 38759079 DOI: 10.3233/ves-240002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
BACKGROUND Health disparities (HD) impact care delivery and health outcomes in individuals with vestibular disorders (IVD). OBJECTIVE The purpose of this study is to identify whether health disparities (HD) exist in Vestibular Rehabilitation (VR) between individuals identifying as Caucasians or racial or ethnic minorities (REM). METHODS This study was a retrospective chart review of IVD who attended outpatient VR between 1/2014 and 9/2020. Data recorded included age, gender, race/ethnicity, vestibular diagnosis, VR interventions, and pre-post outcome measures such as Dizziness Handicap Inventory (DHI), and Activities-Specific Balance Confidence Scale (ABC), Gait speed (GS), and Functional Gait Assessment (FGA). Chi-squared tests, one-tailed, and two-tailed t-tests (α= 0.05) were utilized to compare Caucasian and REM groups. RESULTS Three hundred and forty-three charts (N = 343) met inclusion/exclusion criteria. REM demonstrated higher median DHI scores (46 vs. 38, p = 0.008) and lower ABC scores (53.10% vs. 66.30%, p < 0.001) at VR evaluation compared to Caucasians. There were no statistically significant differences in DHI, ABC, FGA, and GS scores between Caucasians and REM at discharge. CONCLUSIONS VR was able to equalize HD in DHI and ABC which initially existed between REM and Caucasians. VR therapists should work with public health and policy researchers to improve access to VR.
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Affiliation(s)
- Rachel D Wellons
- Department of Physical Therapy, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Sydney E Duhe
- Our Lady of the Lake Hearing and Balance Center, Baton Rouge, LA, USA
| | - Sara G MacDowell
- Our Lady of the Lake Hearing and Balance Center, Baton Rouge, LA, USA
| | | | - Madhav Kc
- Yale School of Medicine, New Haven, CT, USA
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Hackenberg B, O'Brien K, Döge J, Lackner KJ, Beutel ME, Münzel T, Wild PS, Pfeiffer N, Chalabi J, Matthias C, Bahr‐Hamm K. Vertigo and its burden of disease-Results from a population-based cohort study. Laryngoscope Investig Otolaryngol 2023; 8:1624-1630. [PMID: 38130247 PMCID: PMC10731510 DOI: 10.1002/lio2.1169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/31/2023] [Accepted: 10/06/2023] [Indexed: 12/23/2023] Open
Abstract
Objectives Vertigo describes symptoms of abnormal movement of the environment or the patient's own body. As such, it affects patients' quality of life, prevents them from following their daily activities, and increases healthcare utilization. The Global Burden of Disease Project aims to quantify morbidity and mortality worldwide. In 2013, a separate disability weight for vertigo was introduced. The aim of this study is to estimate the symptom burden of disease caused by vertigo. Methods This study analyzes data from the Gutenberg Health Study (GHS). The GHS is a population-based cohort study representative of the city of Mainz and its district. Participants were asked whether they suffered from vertigo and, if so, how bothered they felt by it, rating their distress on a six-level scale from 1 = little stressful to 6 = extremely stressful. Results Eight thousand five hundred and nineteen participants could be included in the study. The overall prevalence of vertigo was 21.6% (95%-confidence interval [CI] [20.7%; 22.5%]). Vertigo prevalence peaked in the age group of 55-64 years. Vertigo annoyance averaged 2.42 (± 1.28). When an annoyance of 3-6 was considered bothersome, the prevalence of bothersome vertigo was 8.1 % (95%-CI [7.5%; 8.7%]). Age-standardized to the European Standard Population 2013, vertigo caused a burden of 2102 years lived with disability per 100,000 population. Conclusion In this study, it was found that one in five people suffer at least occasionally from vertigo. This result suggests a significant burden of disease. This burden is reported at the symptom level. Future studies are needed to attribute the burden to specific causes. Level of Evidence 2.
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Affiliation(s)
- Berit Hackenberg
- Department of OtorhinolaryngologyUniversity Medical Center MainzMainzGermany
| | - Karoline O'Brien
- Department of OtorhinolaryngologyUniversity Medical Center MainzMainzGermany
| | - Julia Döge
- Department of OtorhinolaryngologyUniversity Medical Center MainzMainzGermany
| | - Karl J. Lackner
- Institute for Clinical Chemistry and Laboratory MedicineUniversity Medical Center MainzMainzGermany
| | - Manfred E. Beutel
- Department of Psychosomatic Medicine and PsychotherapyUniversity Medical Center MainzMainzGermany
| | - Thomas Münzel
- Department of Cardiology—Cardiology IUniversity Medical Center MainzMainzGermany
| | - Philipp S. Wild
- Preventive Cardiology and Preventive Medicine—Department of CardiologyUniversity Medical Center MainzMainzGermany
- Center for Thrombosis and HemostasisUniversity Medical Center MainzMainzGermany
- DZHK (German Center for Cardiovascular Research), Partner Site RhineMainMainzGermany
- Institute of Molecular Biology (IMB)MainzGermany
| | - Norbert Pfeiffer
- Department of OphthalmologyUniversity Medical Center MainzMainzGermany
| | - Julian Chalabi
- Preventive Cardiology and Preventive Medicine—Department of CardiologyUniversity Medical Center MainzMainzGermany
| | - Christoph Matthias
- Department of OtorhinolaryngologyUniversity Medical Center MainzMainzGermany
| | - Katharina Bahr‐Hamm
- Department of OtorhinolaryngologyUniversity Medical Center MainzMainzGermany
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Homøe AS, Thorup N, Larsen CVL, Homøe P. Prevalence of self-reported middle ear disease, hearing loss and vertigo in two adult population-based cohorts over a 20-year period in Greenland. Int J Circumpolar Health 2023; 82:2183588. [PMID: 36853877 PMCID: PMC9980023 DOI: 10.1080/22423982.2023.2183588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
To estimate the frequencies of self-reported middle ear and hearing complaints and vertigo/dizziness in adult Greenlanders. Furthermore, to examine if there has been a development in the frequency of these complaints within a 20-year period. A structured questionnaire concerning middle ear disease and related neuro-otological symptoms was mailed to 400 randomly selected adult Greenlanders between 18 and 60 years of age in 1995. In 2014, the questions were included for the same age group in the general Greenlandic Health Survey. The questionnaires contained a total of six identical questions. In 1995, 281 participants (70%) replied to the questionnaire. In 2014, 1,639 participants (78%) replied. We found that in 1995 the two youngest age groups (18-29- and 30-39-year-olds) had the highest relative number of ear discharge. Approximately one-third of the participants in these two age groups reported to have had ear discharge, while this was only reported by 17% of the 18-29-year-olds and 16% of the 30-39-year-olds in 2014 (95% CI [0.03, 0.3] and [0.1, 0.3], respectively). The oldest age group indicated the lowest relative number of experiences of ear discharge in both 1995 and 2014 (18% and 17%, respectively). In 1995, 30% in the age group 30-39-year-olds reported hearing loss, whereas only 18% reported hearing loss in 2014 (p < 0.05, 95% CI [-0.003,0.2]). There was no significant difference in reported ear discharge since childhood and otitis media in childhood among the age groups between 1995 and 2014. However, in 1995 significantly more females had experienced ear discharge in the age groups 18-29 and 30-39 year-olds compared to 2014. Females in the age group 18-29 year-olds also showed a significant difference in having experienced otitis media in childhood, where 32% answered "yes" in 1995, and 18% answered "yes" in 2014 (p < 0.05). In 2014, females reported more frequent complaints of vertigo compared to males, 16% and 9%, respectively (p < 0.05). In 1995, there was no significant difference in experienced vertigo between males and females. Ear and hearing health problems and vertigo are reported frequently in the Greenlandic population. Overall, a tendency of less complaints in 2014 compared to 1995 except for vertigo. It is important to follow this trend and increase the prophylactic efforts to reduce common health disabilities like early otitis media in childhood and noise created symptoms even more.
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Affiliation(s)
- AS Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark,CONTACT AS Homøe Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Lykkebækvej 1, Køge4600, Denmark
| | - N Thorup
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - CVL Larsen
- University of Greenland, Nuussuaq, Greenland,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - P Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark,University of Greenland, Nuussuaq, Greenland,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
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Alateeq M, Hafiz TA, Alnizari O. Measuring the Effect of Smoking or Tobacco Use on Vertigo Among the Adult Population in the Kingdom of Saudi Arabia. Cureus 2023; 15:e38516. [PMID: 37288209 PMCID: PMC10243229 DOI: 10.7759/cureus.38516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 06/09/2023] Open
Abstract
Background Smoking is widespread at all ages in Saudi society. In addition, complaints of vertigo are common. A key problem is how smoking affects vertigo and, thus, quality of life. Researchers have investigated the association between smoking and vertigo and found that smoking may be a risk factor for vertigo, but this association is not clear. The current study aims to investigate the association between smoking and vertigo. Materials and methods We conducted a cross-sectional study from March 2022 to January 2023 to investigate the effect of smoking on vertigo in Saudi Arabia's adult population. Results We found that smokers were more prone to vertigo than non-smokers. In addition, the severity of vertigo increases as the number of cigarettes smoked or the length of time in years that the person has smoked increases. Conclusion The findings of the study should inspire more research into the impact of demographic factors on vertigo among smokers.
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Affiliation(s)
- Mohahmmed Alateeq
- Otolaryngology-Head and Neck Surgery, University of Hail College of Medicine, Hail, SAU
| | | | - Osama Alnizari
- Family Medicine, University of Hail College of Medicine, Hail, SAU
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Mitchell MB, Bhattacharyya N. Balance Disorder Trends in US Adults 2008-2016: Epidemiology and Functional Impact. OTO Open 2023; 7:e58. [PMID: 37287493 PMCID: PMC10242407 DOI: 10.1002/oto2.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 06/09/2023] Open
Abstract
Objective To quantify the changes in prevalence and impact of dizziness and balance disorders in adults from 2008 to 2016. Study Design Epidemiological survey analysis. Setting United States. Methods The balance modules of the adult 2008 and 2016 National Health Interview Surveys were examined, and persons reporting dizziness or balance problems identified. The prevalence of balance problems was determined and compared over time, adjusting for age and sex. Among those with balance problems, associated symptoms and self-reported functional limitations were quantified and compared over time. Results In 2016, 36.8 ± 1.0 million (15.5% ± 0.3%) adults reported a balance problem in the past year, versus 24.2 ± 0.7 million (11.% ± 0.3%) in 2008 (p < .001). After adjustment for age and sex, this percentage increase remained significant (odds ratio 1.435 [1.332-1.546], p < .001). Among those with balance problems, significantly more patients reported specific issues with feeling: off-balance (69.4% vs. 65.4%; p = .005), faint (48.5% vs. 40.3%; p < .001), or vertiginous (45.9% vs. 39.3%; p < .001) in 2016 than 2008. More adults experienced anxiety (29.4% vs. 19.4%; p < .001) and depression (16.3% vs. 12.9%; p = .002) with their balance problems in 2016 than in 2008. In 2016, adults with balance problems were limited in ability to drive motor vehicles (13.0%), exercise (14.4%), or walk downstairs (12.8%). These rates were not significantly different from 2008 (all p > .05). Conclusion In this nationally representative analysis, we found a significantly increasing prevalence of balance problems and associated psychiatric symptom burden. This merits attention with respect to present and future health care resource allocation.
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Affiliation(s)
- Margaret B. Mitchell
- Department of Otolaryngology‐Head & Neck SurgeryMassachusetts Eye & EarBostonMassachusettsUSA
| | - Neil Bhattacharyya
- Department of Otolaryngology‐Head & Neck SurgeryMassachusetts Eye & EarBostonMassachusettsUSA
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10
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Souza WH, Grove CR, Gerend PL, Ryan C, Schubert MC. Regional differences in patient-reported outcomes as a proxy of healthcare practices for Americans living with vestibular symptoms. J Vestib Res 2022; 32:541-551. [PMID: 35811550 DOI: 10.3233/ves-220022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Geographical location is known to affect health outcomes; however, evidence regarding whether location affects healthcare for persons suspected to have vestibular dysfunction is lacking. OBJECTIVE To investigate whether location affects healthcare seeking and outcomes for adults with symptoms of vestibular pathology. METHODS We assessed for regional disparities associated with demographics, diagnosis, chronological factors, and financial expenditures from Americans who participated in the Vestibular Disorders Association registry (N = 905, 57.4±12.5 years, 82.7% female, 94.8% White, and 8.1% Hispanic or Latino). Respondents were grouped per geographical regions defined by the United States Census Bureau. RESULTS There were no significant between-region differences for age (p = 0.10), sex (p = 0.78), or ethnicity (p = 0.24). There were more Asian respondents in the West versus the Midwest (p = 0.05) and more Black respondents in the South versus the West (p = 0.05). The time to first seek care was shorter in the Northeast (17.3 [SD = 49.5] weeks) versus the South (42.4 [SD = 83.7] weeks), p = 0.015. The time from the first healthcare visit to receiving a final diagnosis was shorter in the Northeast (46.5 [SD = 75.4] weeks) versus the South (68.9 [SD = 89.7] weeks), p = 0.015. Compared to the Midwest, fewer respondents in the Northeast reported "no" out-of-pocket financial impact, p = 0.039. CONCLUSIONS Geographical location affects healthcare seeking and outcomes for persons suspected to have vestibular dysfunction.
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Affiliation(s)
- Wagner Henrique Souza
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Colin R Grove
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
| | | | - Cynthia Ryan
- VEDA Vestibular Disorders Association (VeDA), Portland, OR, USA
| | - Michael C Schubert
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA.,Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
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Kim EJ, Song HJ, Lee HI, Kwon E, Jeong SH. One-year prevalence and clinical characteristics in chronic dizziness: The 2019-2020 Korean National Health and Nutrition Examination Survey. Front Neurol 2022; 13:1016718. [PMID: 36530637 PMCID: PMC9751592 DOI: 10.3389/fneur.2022.1016718] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/17/2022] [Indexed: 11/03/2023] Open
Abstract
INTRODUCTION In this cross-sectional study, we investigated the 1-year prevalence and related factors in the general population with an experience of chronic dizziness. METHODS This study analyzed persons (n = 5,163) who respond to dizziness and nutrition questionnaire from participant of Korean National Health and Nutrition Examination Survey (KNHANES, 2019-2020). RESULTS Of individuals over 40 years, 25.3% of the general population (61.6% females) reported either dizziness or imbalance for the past year. Moreover, 4.8% of the patients reported they suffered from chronic dizziness or imbalance for more than 3 months. In multiple regression analysis, patients with chronic dizziness were older, females, had lower body mass index (BMI), had stress awareness, and had a history of tinnitus within 1 year (>5 min per episode). Relative to normal body weight, both overweight and mild obesity (obesity stages 1 and 2) were associated with a significantly lower risk of chronic dizziness. Overweight, obesity stage 1, and obesity stage 2 had odds ratios of 0.549 [95% confidence interval (CI), 0.332-0.910], 0.445 (95% CI, 0.273-0.727), and 0.234 (95% CI, 0.070-0.779), respectively. CONCLUSIONS In this study, the prevalence of chronic dizziness in the general population was 4.8%. Our study demonstrated that overweight and mild obesity were independently associated with a lower risk of chronic dizziness in adults for the past year. Therefore, the optimal BMI for patients with dizziness should be defined and managed according to an integrated care pathway.
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Affiliation(s)
- Eun Ji Kim
- Department of Neurology, Chungnam National University Hospital, Daejeon, South Korea
| | - Hee-Jung Song
- Department of Neurology, Chungnam National University Sejong Hospital, Sejong, South Korea
- Department of Neurology, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Hak In Lee
- Department of Neurology, Chungnam National University Hospital, Daejeon, South Korea
| | - Eunjin Kwon
- Department of Neurology, Chungnam National University Hospital, Daejeon, South Korea
| | - Seong-Hae Jeong
- Department of Neurology, Chungnam National University Hospital, Daejeon, South Korea
- Department of Neurology, Chungnam National University School of Medicine, Daejeon, South Korea
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12
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Mallampalli MP, Rizk HG, Kheradmand A, Beh SC, Abouzari M, Bassett AM, Buskirk J, Ceriani CEJ, Crowson MG, Djalilian H, Goebel JA, Kuhn JJ, Luebke AE, Mandalà M, Nowaczewska M, Spare N, Teggi R, Versino M, Yuan H, Zaleski-King A, Teixido M, Godley F. Care Gaps and Recommendations in Vestibular Migraine: An Expert Panel Summit. Front Neurol 2022; 12:812678. [PMID: 35046886 PMCID: PMC8762211 DOI: 10.3389/fneur.2021.812678] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/29/2021] [Indexed: 12/03/2022] Open
Abstract
Vestibular migraine (VM) is an increasingly recognized pathology yet remains as an underdiagnosed cause of vestibular disorders. While current diagnostic criteria are codified in the 2012 Barany Society document and included in the third edition of the international classification of headache disorders, the pathophysiology of this disorder is still elusive. The Association for Migraine Disorders hosted a multidisciplinary, international expert workshop in October 2020 and identified seven current care gaps that the scientific community needs to resolve, including a better understanding of the range of symptoms and phenotypes of VM, the lack of a diagnostic marker, a better understanding of pathophysiologic mechanisms, as well as the lack of clear recommendations for interventions (nonpharmacologic and pharmacologic) and finally, the need for specific outcome measures that will guide clinicians as well as research into the efficacy of interventions. The expert group issued several recommendations to address those areas including establishing a global VM registry, creating an improved diagnostic algorithm using available vestibular tests as well as others that are in development, conducting appropriate trials of high quality to validate current clinically available treatment and fostering collaborative efforts to elucidate the pathophysiologic mechanisms underlying VM, specifically the role of the trigemino-vascular pathways.
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Affiliation(s)
- Monica P Mallampalli
- Department of Research, Association of Migraine Disorders, North Kingstown, RI, United States
| | - Habib G Rizk
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Amir Kheradmand
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Shin C Beh
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Mehdi Abouzari
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, CA, United States
| | - Alaina M Bassett
- Department of Otolaryngology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - James Buskirk
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Claire E J Ceriani
- Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Matthew G Crowson
- Department of Otolaryngology-Head and Neck Surgery, Mass Eye & Ear and Harvard Medical School, Boston, MA, United States
| | - Hamid Djalilian
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, CA, United States
| | - Joel A Goebel
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, United States
| | - Jeffery J Kuhn
- Department of Research, Bayview Physicians Group, Chesapeake, VA, United States
| | - Anne E Luebke
- Biomedical Engineering and Neuroscience, University of Rochester Medical Center, Rochester, NY, United States
| | - Marco Mandalà
- Otolaryngology Unit, University of Siena, Siena, Italy
| | - Magdalena Nowaczewska
- Department of Otolaryngology, Head and Neck Surgery, Laryngological Oncology, Nicolaus Copernicus University, Torun, Poland
| | - Nicole Spare
- Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Roberto Teggi
- Department of Otolaryngology, San Raffaele Scientific Hospital, Milan, Italy
| | - Maurizio Versino
- Neurology and Stroke Unit, ASST Sette Laghi, Circolo Hospital, Varese, Italy
| | - Hsiangkuo Yuan
- Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Ashley Zaleski-King
- Department of Speech-Language Pathology & Audiology, Towson University, Towson, MD, United States
| | - Michael Teixido
- Department of Research, Association of Migraine Disorders, North Kingstown, RI, United States
| | - Frederick Godley
- Department of Research, Association of Migraine Disorders, North Kingstown, RI, United States
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13
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Adams ME, Marmor S. Dizziness Diagnostic Pathways: Factors Impacting Setting, Provider, and Diagnosis at Presentation. Otolaryngol Head Neck Surg 2022; 166:158-166. [PMID: 33845655 PMCID: PMC9258633 DOI: 10.1177/01945998211004245] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Ensuring that patients with dizziness present to the most appropriate level of care and provider are key goals of quality and cost improvement efforts. Using a symptom-defined cohort of adults presenting for dizziness evaluations, we aimed to identify patient factors associated with ambulatory clinic vs emergency department (ED) presentations, evaluating provider specialty, and assigned diagnoses. STUDY DESIGN Cross-sectional study. SETTING OptumLabs Data Warehouse (OLDW), a longitudinal, real-world data asset with deidentified administrative claims. METHODS We performed a cross-sectional analysis of adults (older than 18 years) who received new dizziness diagnoses (2006-2015) and identified factors associated with setting and provider at initial presentation using multivariable regression models. RESULTS Of 805,454 individuals with dizziness (median age 52 years, 62% women, 29% black, Asian, or Hispanic), 23% presented to EDs and 77% to clinics (76% primary care, 7% otolaryngology, 5% cardiology, 3% neurology). Predictors of ED presentation were younger age, male sex, black race, lower education, and medical comorbidity. Predictors of primary care clinic presentation were older age and race/ethnicity other than white. Nonetiologic symptom diagnoses alone were assigned to 51% and were most associated with age older than 75 years (odds ratio, 2.90; 95% CI, 2.86-2.94). CONCLUSION Adults with dizziness often present to a level of care that may be higher than is optimal. Differential care seeking and diagnoses by age, sex, and race/ethnicity reflect influences beyond dizziness presentation acuity. Targeted patient resources, triage systems, provider education, and cross-specialty partnerships are needed to direct dizzy patients to appropriate settings and providers to improve care.
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Affiliation(s)
- Meredith E. Adams
- Department of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Schelomo Marmor
- Department of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA,Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA,Center for Clinical Quality and Outcomes Discovery and Evaluation (CQODE), University of Minnesota, Minneapolis, Minnesota, USA
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14
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Wong EC, Chiao W, Strangio BT, Luong K, Pasquesi L, Allen IE, Sharon JD. Understanding Extremely Elevated Dizziness Handicap Inventory Scores: An Analysis of Predictive Factors. Ann Otol Rhinol Laryngol 2021; 131:1068-1077. [PMID: 34694153 DOI: 10.1177/00034894211053788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Dizziness Handicap Inventory (DHI) measures impairment in quality of life due to dizziness, with higher scores indicating greater impairment. Little is known about the clinical features that predict extremely elevated DHI scores (eeDHI). OBJECTIVE To identify clinical features associated with eeDHI. METHODS A retrospective analysis was conducted of 217 patients with dizziness between October 2016 and April 2019. Patients with eeDHI had DHI scores 1 standard deviation higher than the mean. Analyses were performed to generate odds ratios (OR) for having eeDHI based on clinical features and exam findings. RESULTS The cut-off for eeDHI scores was 71. In total, 20.7% had eeDHI. Logistic regression identified 6 independent predictors for eeDHI scores: numbness in the face or body during dizziness (OR = 5.99, 95% CI 1.77-20.30), history of falls (OR = 4.37, 95% CI 1.74-10.97), female sex (OR = 2.81, 95% CI 1.18-6.66), caloric weakness (OR = 2.61, 95% CI 1.36-5.01), total number of diagnoses associated with dizziness (OR = 2.17, 95% CI 1.11-4.28), and total number of symptoms during dizziness (OR = 1.25, 95% CI 1.07-1.45). CONCLUSIONS These findings suggest that patients with eeDHI have severe disease and should be screened for falls. By understanding the drivers of high DHI scores, we can alleviate disease related suffering for vestibular disorders.
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Affiliation(s)
- Emily C Wong
- University of California, San Francisco, CA, USA
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15
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Zuniga SA, Marmor S, Adams ME. Variation in Canalith Repositioning Procedure Use Among Medicare Beneficiaries: Understanding the Role of Geographic Region and Provider Specialty. Otol Neurotol 2021; 42:e911-e917. [PMID: 34260509 PMCID: PMC9258631 DOI: 10.1097/mao.0000000000003112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Clinical practice guidelines recommend canalith repositioning procedures (CRPs) for the management of benign paroxysmal positional vertigo (BPPV). As only 10 to 20% of affected individuals receive CRPs, there is concern for guideline adherence and knowledge dissemination to relevant medical specialties. This study aimed to characterize patterns of CRP utilization over time, across all United States regions, and by provider specialty. STUDY DESIGN Cross-sectional analysis with time trends of CRP claims in the Centers for Medicare and Medicaid Service Provider Utilization and Payment database, 2012 to 2017. SETTING National administrative claims data. PATIENTS Fee-for-service Medicare beneficiaries. INTERVENTIONS Canalith repositioning procedures. MAIN OUTCOME MEASURES CRP utilization was analyzed by year, hospital referral region (HRR), and provider specialty. RESULTS From 2012 to 2017, 253,894 CRPs were performed on 146,139 Medicare beneficiaries and CRP utilization increased 80%. CRP use varied widely by geographic region. In 2017, CRP use per 100,000 beneficiaries varied 113-fold across HRRs (range, 6.0-701.8, interquartile range, 68.4, extremal ratio, 116.9). Most CRPs were performed by otolaryngologists (50.9%) and physical therapists (34.3%) with few by primary care providers (1.3%). CONCLUSIONS CRP utilization increased substantially suggesting improved dissemination and implementation of BPPV management guidelines. Nevertheless, wide geographic and provider-level variation remained, signifying non-uniform provider practices and access to care. Care for BPPV may thus be improved through education and incentivization of a broader range of providers.
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Affiliation(s)
| | - Schelomo Marmor
- Department of Otolaryngology-Head and Neck Surgery
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
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16
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Abstract
While the majority of vestibular disorders may be diagnosed solely on clinical grounds, a variety of clinical scenarios exist in which objective functional assessment of the vestibular system provides data that facilitate diagnosis and treatment decisions. There exists a veritable armamentarium of sophisticated vestibular test modalities, including videonystagmography, rotary chair testing, video head impulse testing, and vestibular-evoked myogenic potentials. This article aims to help clinicians apply an accessible decision-making rubric to identify the clinical scenarios that may and may not benefit from data derived from specific vestibular function tests.
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Affiliation(s)
- Steven A Zuniga
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, 420 Delaware Street, MMC 396, Minneapolis, MN 55455, USA.
| | - Meredith E Adams
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, 420 Delaware Street, MMC 396, Minneapolis, MN 55455, USA
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17
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Subjective Cognitive Symptoms and Dizziness Handicap Inventory (DHI) Performance in Patients With Vestibular Migraine and Menière's Disease. Otol Neurotol 2021; 42:883-889. [PMID: 33606474 DOI: 10.1097/mao.0000000000003081] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Cognitive symptoms in patients with vestibular disorders are far from rare, but identification of patients at risk for cognitive impairment remains poor. The Dizziness Handicap Inventory (DHI) is a widely used patient-reported outcome questionnaire for dizzy patients with several questions that address cognitive function. However, the relationship between subjective cognitive symptomatology in patients with vestibular disorders and performance on DHI is poorly characterized. STUDY DESIGN Retrospective cohort study. SETTING Tertiary care vestibular clinic. SUBJECTS Individuals with diagnoses of vestibular migraine (VM), Menière's disease (MD), and concomitant vestibular migraine and Menière's disease (VMMD) presenting to clinic between January 2007 and December 2019. RESULTS Of 761 subjects, 365 had VM, 311 had MD, and 85 had VMMD. Symptoms of brain fog and chronic fatigue occurred more frequently in the VM and VMMD groups compared with the MD group (χ2 (df = 2, n = 761) = 67.8, 20.9, respectively, p < 0.0001). DHI scores were significantly higher in patients with VM and VMMD compared with those with MD (F[2,758] = 63.5, p < 0.001). A DHI score ≥ 13 suggested that the patient suffered from brain fog (sensitivity = 47.4%, specificity = 72.3%), whereas a score ≥ 15 indicated that the patient complained of chronic fatigue (sensitivity = 81.5%, specificity = 57.7%). CONCLUSION Our results indicate a high prevalence of interictal cognitive symptoms in patients with episodic vestibular disorders. The DHI cannot be reliably used to differentiate between vestibular disorders nor detect cognitive impairment in these patient populations. Alternative methods must be used to identify vestibulopathic patients with cognitive symptoms to initiate strategies for prevention and treatment.
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18
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Bayat A, Hoseinabadi R, Saki N, Sanayi R. Disability and Anxiety in Vestibular Diseases: A Cross-Sectional Study. Cureus 2020; 12:e11813. [PMID: 33409058 PMCID: PMC7781499 DOI: 10.7759/cureus.11813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Patients with dizziness and vertigo usually experience psychological, physical, and social functioning limitations that may affect their daily living activities. In order to better understand disability and anxiety in patients with vertigo, in the present study we aimed to investigate the correlation between disability and anxiety in four different types of diseases causing vertigo. Moreover, the difference between the observed disabilities in these etiologies of vertigo was studied. Materials and methods In this analytic cross-sectional design, 130 patients (52 male, 78 female; age range: 18-75 years) with dizziness/vertigo who were referred to our balance clinic participated. All patients underwent a detailed diagnostic procedure including neurological, clinical, and otological evaluations. Dizziness Handicap Inventory (DHI) and the Beck Anxiety Inventory (BAI) were used to assess handicap and anxiety, respectively. Results There were no significant differences in "total DHI" and DHI subcomponent scores among different study populations (p>0.05). In terms of the BAI score, the one-way analysis of variance (ANOVA) test indicated no significant differences among the four groups (p=0.158). Our results exhibited a significant positive correlation between the BAI and "total DHI" and "DHI subcomponents" values. Conclusion The degree of disability and anxiety is not different between patients with Benign paroxysmal positional vertigo (BPPV), Meniere's disease (MD), unilateral weakness (UW), and central causes. The significant positive correlation between the BAI and "total DHI" and "DHI subcomponents" values shows that the possibility of anxiety in patients with vertigo should not be ignored.
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Affiliation(s)
- Arash Bayat
- Hearing Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IRN
| | - Reza Hoseinabadi
- Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, IRN
| | - Nader Saki
- Hearing Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IRN
| | - Roya Sanayi
- Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, IRN
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19
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van der Lubbe MFJA, Vaidyanathan A, Van Rompaey V, Postma AA, Bruintjes TD, Kimenai DM, Lambin P, van Hoof M, van de Berg R. The "hype" of hydrops in classifying vestibular disorders: a narrative review. J Neurol 2020; 267:197-211. [PMID: 33201310 PMCID: PMC7718205 DOI: 10.1007/s00415-020-10278-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 10/03/2020] [Accepted: 10/14/2020] [Indexed: 12/11/2022]
Abstract
Background Classifying and diagnosing peripheral vestibular disorders based on their symptoms is challenging due to possible symptom overlap or atypical clinical presentation. To improve the diagnostic trajectory, gadolinium-based contrast-enhanced magnetic resonance imaging of the inner ear is nowadays frequently used for the in vivo confirmation of endolymphatic hydrops in humans. However, hydrops is visualized in both healthy subjects and patients with vestibular disorders, which might make the clinical value of hydrops detection on MRI questionable. Objective To investigate the diagnostic value of clinical and radiological features, including the in vivo visualization of endolymphatic hydrops, for the classification and diagnosis of vestibular disorders. Methods A literature search was performed in February and March 2019 to estimate the prevalence of various features in healthy subjects and in common vestibular disorders to make a graphical comparison between healthy and abnormal. Results Of the features studied, hydrops was found to be a highly prevalent feature in Menière’s disease (99.4%). Though, hydrops has also a relatively high prevalence in patients with vestibular schwannoma (48.2%) and in healthy temporal bones (12.5%) as well. In patients diagnosed with (definite or probable) Menière’s disease, hydrops is less frequently diagnosed by magnetic resonance imaging compared to the histological confirmation (82.3% versus 99.4%). The mean prevalence of radiologically diagnosed hydrops was 31% in healthy subjects, 28.1% in patients with vestibular migraine, and 25.9% in patients with vestibular schwannoma. An interesting finding was an absolute difference in hydrops prevalence between the two diagnostic techniques (histology and radiology) of 25.2% in patients with Menière’s disease and 29% in patients with vestibular schwannoma. Conclusions Although the visualization of hydrops has a high diagnostic value in patients with definite Menière’s disease, it is important to appreciate the relatively high prevalence of hydrops in healthy populations and other vestibular disorders. Endolymphatic hydrops is not a pathognomic phenomenon, and detecting hydrops should not directly indicate a diagnosis of Menière’s disease. Both symptom-driven and hydrops-based classification systems have disadvantages. Therefore, it might be worth to explore features “beyond” hydrops. New analysis techniques, such as Radiomics, might play an essential role in (re)classifying vestibular disorders in the future. Electronic supplementary material The online version of this article (10.1007/s00415-020-10278-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marly F J A van der Lubbe
- Department of Otolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Akshayaa Vaidyanathan
- The D-Lab, department of Precision Medicine, GROW research institute for Oncology, Maastricht University, Maastricht, The Netherlands
- Research and Development, Oncoradiomics SA, Liege, Belgium
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Alida A Postma
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Sciences, Maastricht University, Maastricht, The Netherlands
| | - Tjasse D Bruintjes
- Department of Otorhinolaryngology, Gelre Hospital, Apeldoorn, The Netherlands
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dorien M Kimenai
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Philippe Lambin
- The D-Lab, department of Precision Medicine, GROW research institute for Oncology, Maastricht University, Maastricht, The Netherlands
| | - Marc van Hoof
- Department of Otolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Raymond van de Berg
- Department of Otolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Sciences, Maastricht University, Maastricht, The Netherlands
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20
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Yang TH, Xirasagar S, Cheng YF, Wu CS, Kuo NW, Lin HC. Peripheral Vestibular Disorders: Nationwide Evidence From Taiwan. Laryngoscope 2020; 131:639-643. [PMID: 32621538 DOI: 10.1002/lary.28877] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/25/2020] [Accepted: 06/01/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study aimed to evaluate the prevalence of peripheral vestibular disorders in an Asian population of predominantly Han Chinese ethnicity. STUDY DESIGN Cross-sectional study. METHODS Patients with a peripheral vertigo disorder were identified from the Taiwan Health Insurance Research Database, a database of all medical claims of a randomly selected, population-representative sample of 2 million enrollees of Taiwan's National Health Insurance system covering over 99% of Taiwan's citizens. In 2016, 59,986 patients received a diagnosis of peripheral vestibular disorders in Taiwan. We calculated the population-wide prevalence rates of peripheral vestibular disorders in 2016 by sex and age group (20 to 24, 25 to 29, 30 to 34, 35 to 39, 40 to 44, 45 to 49, 50 to 54, 55 to 59, 60 to 64, 65 to 69, and ≥ 70 years) stratified into five urbanization levels. RESULTS The prevalence rate of peripheral vestibular disorders was 2,833.4 per 100,000 population during the year. Prevalence of Meniere's disease was 70.4 per 100,000, benign paroxysmal positional vertigo, 446.4, vestibular neuritis 307.2, and other or unspecified peripheral vestibular dizziness, 2,009.5 per 100,000. Prevalence rates steadily increased with age for every type of peripheral vestibular disorder, and were higher among females compared to males. The female-to-male gender ratios were 1.84, 1.89, and 1.93 for Meniere's disease, vestibular neuritis, and other peripheral vestibular dizziness, respectively. Counties with the lowest urbanization level had the highest prevalence rates of all types of peripheral vestibular disorders except vestibular neuritis. CONCLUSIONS Results showed that peripheral vestibular disorders are common in Taiwan, increase with age, are predominantly female, and show higher prevalence in rural areas. LEVEL OF EVIDENCE 2b Laryngoscope, 131:639-643, 2021.
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Affiliation(s)
- Tzong-Hann Yang
- Department of Otorhinolaryngology, Taipei City Hospital, Taipei, Taiwan.,Department of Speech, Language, and Audiology, National Taipei University of Nursing and Health, Taipei, Taiwan.,Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sudha Xirasagar
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, U.S.A
| | - Yen-Fu Cheng
- Department of Speech, Language, and Audiology, National Taipei University of Nursing and Health, Taipei, Taiwan.,Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chuan-Song Wu
- Department of Otorhinolaryngology, Taipei City Hospital, Taipei, Taiwan.,Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,College of Science and Engineering, Fu Jen University, New Taipei City, Taiwan
| | - Nai-Wen Kuo
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Herng-Ching Lin
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan.,Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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21
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Basura GJ, Adams ME, Monfared A, Schwartz SR, Antonelli PJ, Burkard R, Bush ML, Bykowski J, Colandrea M, Derebery J, Kelly EA, Kerber KA, Koopman CF, Kuch AA, Marcolini E, McKinnon BJ, Ruckenstein MJ, Valenzuela CV, Vosooney A, Walsh SA, Nnacheta LC, Dhepyasuwan N, Buchanan EM. Clinical Practice Guideline: Ménière's Disease Executive Summary. Otolaryngol Head Neck Surg 2020; 162:415-434. [PMID: 32267820 DOI: 10.1177/0194599820909439] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Ménière's disease (MD) is a clinical condition defined by spontaneous vertigo attacks (each lasting 20 minutes to 12 hours) with documented low- to midfrequency sensorineural hearing loss in the affected ear before, during, or after one of the episodes of vertigo. It also presents with fluctuating aural symptoms (hearing loss, tinnitus, or ear fullness) in the affected ear. The underlying etiology of MD is not completely clear, yet it has been associated with inner ear fluid volume increases, culminating in episodic ear symptoms (vertigo, fluctuating hearing loss, tinnitus, and aural fullness). Physical examination findings are often unremarkable, and audiometric testing may or may not show low- to midfrequency sensorineural hearing loss. Imaging, if performed, is also typically normal. The goals of MD treatment are to prevent or reduce vertigo severity and frequency; relieve or prevent hearing loss, tinnitus, and aural fullness; and improve quality of life. Treatment approaches to MD are many, and approaches typically include modifications of lifestyle factors (eg, diet) and medical, surgical, or a combination of therapies. PURPOSE The primary purpose of this clinical practice guideline is to improve the quality of the diagnostic workup and treatment outcomes of MD. To achieve this purpose, the goals of this guideline are to use the best available published scientific and/or clinical evidence to enhance diagnostic accuracy and appropriate therapeutic interventions (medical and surgical) while reducing unindicated diagnostic testing and/or imaging.
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Affiliation(s)
| | | | | | | | | | | | - Matthew L Bush
- University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Julie Bykowski
- University of California San Diego, San Diego, California, USA
| | - Maria Colandrea
- Duke University School of Nursing and Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | | | | | - Kevin A Kerber
- University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | | | | | - Evie Marcolini
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Brian J McKinnon
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | | | | | | | - Sandra A Walsh
- Consumers United for Evidence-Based Healthcare, Baltimore, Maryland, USA
| | - Lorraine C Nnacheta
- American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA
| | - Nui Dhepyasuwan
- American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA
| | - Erin M Buchanan
- American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA
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Basura GJ, Adams ME, Monfared A, Schwartz SR, Antonelli PJ, Burkard R, Bush ML, Bykowski J, Colandrea M, Derebery J, Kelly EA, Kerber KA, Koopman CF, Kuch AA, Marcolini E, McKinnon BJ, Ruckenstein MJ, Valenzuela CV, Vosooney A, Walsh SA, Nnacheta LC, Dhepyasuwan N, Buchanan EM. Clinical Practice Guideline: Ménière's Disease. Otolaryngol Head Neck Surg 2020; 162:S1-S55. [PMID: 32267799 DOI: 10.1177/0194599820909438] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Ménière's disease (MD) is a clinical condition defined by spontaneous vertigo attacks (each lasting 20 minutes to 12 hours) with documented low- to midfrequency sensorineural hearing loss in the affected ear before, during, or after one of the episodes of vertigo. It also presents with fluctuating aural symptoms (hearing loss, tinnitus, or ear fullness) in the affected ear. The underlying etiology of MD is not completely clear, yet it has been associated with inner ear fluid (endolymph) volume increases, culminating in episodic ear symptoms (vertigo, fluctuating hearing loss, tinnitus, and aural fullness). Physical examination findings are often unremarkable, and audiometric testing may or may not show low- to midfrequency sensorineural hearing loss. Conventional imaging, if performed, is also typically normal. The goals of MD treatment are to prevent or reduce vertigo severity and frequency; relieve or prevent hearing loss, tinnitus, and aural fullness; and improve quality of life. Treatment approaches to MD are many and typically include modifications of lifestyle factors (eg, diet) and medical, surgical, or a combination of therapies. PURPOSE The primary purpose of this clinical practice guideline is to improve the quality of the diagnostic workup and treatment outcomes of MD. To achieve this purpose, the goals of this guideline are to use the best available published scientific and/or clinical evidence to enhance diagnostic accuracy and appropriate therapeutic interventions (medical and surgical) while reducing unindicated diagnostic testing and/or imaging.
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Affiliation(s)
| | | | | | | | | | | | - Matthew L Bush
- University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Julie Bykowski
- University of California San Diego, San Diego, California, USA
| | - Maria Colandrea
- Duke University School of Nursing and Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | | | | | - Kevin A Kerber
- University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | | | | | - Evie Marcolini
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Brian J McKinnon
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | | | | | | | - Sandra A Walsh
- Consumers United for Evidence-Based Healthcare, Baltimore, Maryland, USA
| | - Lorraine C Nnacheta
- American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA
| | - Nui Dhepyasuwan
- American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA
| | - Erin M Buchanan
- American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA
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Dunlap PM, Khoja SS, Whitney SL, Freburger JK. Predictors of Physical Therapy Referral Among Persons With Peripheral Vestibular Disorders in the United States. Arch Phys Med Rehabil 2020; 101:1747-1753. [PMID: 32445851 DOI: 10.1016/j.apmr.2020.04.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/15/2020] [Accepted: 04/19/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the rate of physical therapy (PT) referral and patient and physician characteristics associated with PT referral for benign paroxysmal positional vertigo (BPPV) and other peripheral vestibular disorders (PVD) in ambulatory care clinics in the United States. DESIGN Cross-sectional analysis of the National Ambulatory Medical Care Survey 2004-2015 SETTING: Ambulatory care clinics in the United States. PARTICIPANTS We identified 5.6 million weighted adult visits for BPPV (International Classification of Diseases-9th Revision-Clinical Modifications (ICD-9-CM): 386.11) and 6.6 million weighted visits for other PVDs (ICD-9-CM: 386.1-386.9, excluding 386.11 and 386.2) made by patients 18 years and older from 2004 through 2015. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Patient, clinical, and physician characteristics were extracted, and descriptive statistics were stratified by referral to PT. Two multivariable logistic regression models were estimated for each diagnostic group (BPPV and other PVDs) to identify predictors of PT referral. RESULTS PT referrals for BPPV increased from 6.2% in the period from 2004 to 2006 to 12.9% in the period from 2013 to 2015, whereas PT referrals for other PVDs decreased from 3.8% in the period from 2004 to 2006 to 0.5% in the period from 2013 to 2015. Other insurance coverage (versus private) and neurologists and other specialists (versus otolaryngologists) were associated with a greater odds of PT referral for BPPV. Visits made in the Midwest and West (versus the Northeast) and in rural versus metropolitan areas had greater odds of PT referral for BPPV. Relative to otolaryngologists, primary care physicians were less likely to refer to PT for other PVDs. Visits made in metropolitan versus rural areas and visits with 1 or more comorbidities (versus none) had greater odds of PT referral for other PVDs. CONCLUSIONS PT referrals remain low for ambulatory care visits for BPPV and other PVDs in the United States. Referral to PT for BPPV and other PVDs varied by insurance type, physician specialty, and office location.
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Affiliation(s)
- Pamela M Dunlap
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA.
| | - Samannaaz S Khoja
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA; Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA
| | - Janet K Freburger
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
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Wolf J, Sattel H, Limburg K, Lahmann C. From illness perceptions to illness reality? Perceived consequences and emotional representations relate to handicap in patients with vertigo and dizziness. J Psychosom Res 2020; 130:109934. [PMID: 31972479 DOI: 10.1016/j.jpsychores.2020.109934] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 01/11/2020] [Accepted: 01/11/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Vertigo and dizziness (VD) are frequent symptoms that can occur due to various structural pathologies or due to functional impairment. Independent of their aetiology, the symptoms are often associated with physical and psychological burden which manifests in severe handicap in more than half of the patients. It is suggested that illness perceptions, the patients' cognitive and emotional concept of their disease, most likely impact the degree of handicap. For patients with VD, however, this relation of illness perceptions and handicap is so far not well understood. This study aimed to investigate the relation of illness perceptions and handicap for patients with VD. METHODS In a cross-sectional study design, n = 419 patients with VD were examined (53.7% female, age 53.5 ± 15.5 years). Participants underwent neurological and psychiatric examinations as well as a comprehensive assessment using self-report questionnaires. RESULTS Illness perceptions, specifically perceived consequences and emotional representations showed a moderate correlation with VD related handicap (r(419) = 0.62, p < .001). Our regression model including symptom severity, psychiatric comorbidity, and aspects of cognitive and emotional illness perceptions accounted for 52% of the variance in VD related handicap. In a moderation analysis, this relation did not differ significantly in patients with functional VD symptoms. CONCLUSION Findings of the present study provide evidence for the relevance of illness perceptions to handicap in patients with VD symptoms.
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Affiliation(s)
- Johannes Wolf
- Department of Psychosomatic Medicine and Psychotherapy, Albert-Ludwigs-Universität Freiburg, Hauptstraße 8, 79104 Freiburg, Germany.
| | - Heribert Sattel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Karina Limburg
- Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, Albert-Ludwigs-Universität Freiburg, Hauptstraße 8, 79104 Freiburg, Germany
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25
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Ostolin TLVDP, Gonze BDB, Jesus MOD, Arantes RL, Sperandio EF, Dourado VZ. Effects of obesity on postural balance and occurrence of falls in asymptomatic adults. FISIOTERAPIA EM MOVIMENTO 2020. [DOI: 10.1590/1980-5918.033.ao50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Previous studies suggested that body weight is a strong predictor for postural balance. High body mass index (BMI) presented an association with increased postural sway. However, it seems controversial since studies reported no difference between obese and control group regarding the position of the center of pressure in static postural balance (PB). Also, there is a lack of investigations about the impact of obesity on PB, free of the confound effect of cardiometabolic risk. Objective: The aim of this study was to evaluate the effects of obesity in static PB and occurrence of falls in asymptomatic adults and older adults over 40 years old. Method: The PB of 624 subjects divided into quartiles for BMI, waist-to-hip ratio, waist-to-height and fat body mass as percentage (%FBM) was assessed with and without vision using a force platform. An MANOVA was used to determine if there were differences between quartiles and a logistic regression analysis adjusted for confounders variables were applied to determine the obesity role in the occurrence of falls. Results: We found weak to moderate bivariate correlations between obesity and static PB, which became non-significant after adjustment. We found significant differences between first and fourth quartiles, especially using %FBM. Obesity was not related to the occurrence of falls since the odds ratio values became non-significant for all the indices of obesity after adjustment. Conclusion: Obesity presents little influence on maintaining static PB and seems not to determine the occurrence of falls among subjects over 40 years old.
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Affiliation(s)
| | | | | | - Rodolfo Leite Arantes
- Universidade Federal de São Paulo, Brazil; Instituto de Medicina Cardiovascular Angiocorpore, Brazil
| | - Evandro Fornias Sperandio
- Universidade Federal de São Paulo, Brazil; Instituto de Medicina Cardiovascular Angiocorpore, Brazil
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Abstract
OBJECTIVES 1. Describe the epidemiology of vestibular migraine (VM) in the United States, using data from the 2008 National Health Interview Survey (NHIS). 2. Characterize the sociodemographic and clinical attributes of people with VM. STUDY DESIGN Population-based nationwide survey study of US adults. PATIENTS Adult respondents to the 2008 NHIS. MAIN OUTCOME MEASURES The responses of participants in the 2008 NHIS balance and dizziness supplement (n = 21,781) were analyzed using statistical software. A case definition for VM was generated based on consensus criteria for diagnosis, and this was applied to the dataset to ascertain the prevalence, demographic, and clinical characteristics of VM. RESULTS The 1-year prevalence of a dizziness or balance problem in the United States was 11.9% (2,490 respondents). Of respondents with dizziness, 584 (23.4%) met our case definition of VM, which represents a prevalence of VM in 2.7% of adults. There was a female preponderance (64.1%) and a slightly younger mean age (40.9 yr) for those with VM as compared with all respondents (51.7% females and 46.0 yr, respectively). Multivariate analysis showed that age less than 40, female sex, anxiety, depression, and prior head trauma were all associated with significantly increased odds of experiencing VM. Only 10% of subjects meeting criteria for VM were told that migraine was the cause of their dizziness. CONCLUSION Using a representative database, we found a much higher prevalence of VM in the United States than previously reported. Results from this study indicate likely under-diagnosis of VM.
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Lin CC, Whitney SL, Loughlin PJ, Furman JM, Redfern MS, Sienko KH, Sparto PJ. The Use of Vibrotactile Feedback During Dual-Task Standing Balance Conditions in People With Unilateral Vestibular Hypofunction. Otol Neurotol 2019; 39:e349-e356. [PMID: 29595580 DOI: 10.1097/mao.0000000000001764] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
HYPOTHESIS People with unilateral vestibular hypofunction (UVH) would have increased postural sway and slower reaction times while using vibrotactile feedback (VTF) during dual-task conditions compared with age-matched controls. BACKGROUND VTF has been shown to improve real-time balance performance in persons with vestibular disorders. Future use of this technology outside of the laboratory environment as a real-time balance aid requires that using VTF during dual-tasking scenarios be studied. METHOD Nine people with UVH and nine age-matched controls participated in a study focused on assessing the effects of a secondary cognitive task and sensory integration conditions on the root-mean-square of center of pressure (RMS COP) while using VTF. Reaction times from the secondary cognitive task were used to assess the effects of VTF, and sensory integration conditions on the attention required to perform the task. RESULTS The results showed that there was no group difference between individuals with UVH and age-matched controls on balance performance while using VTF during dual-task conditions. Using VTF significantly degraded the reaction time performance in both groups, and the participants with UVH had slower reaction times compared with controls. CONCLUSION People with UVH showed the ability to use VTF to control balance during dual-task conditions, but more attentional resources were needed to perform the secondary cognitive tasks while using VTF.
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Affiliation(s)
- Chia-Cheng Lin
- Department of Physical Therapy, University of Pittsburgh, Pennsylvania.,Department of Physical Therapy, East Carolina University, North Carolina
| | - Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pennsylvania.,Department of Otolaryngology
| | | | - Joseph M Furman
- Department of Physical Therapy, University of Pittsburgh, Pennsylvania.,Department of Otolaryngology.,Department of Bioengineering, University of Pittsburgh, Pennsylvania
| | - Mark S Redfern
- Department of Otolaryngology.,Department of Bioengineering, University of Pittsburgh, Pennsylvania
| | - Kathleen H Sienko
- Departments of Mechanical and Biomedical Engineering, University of Michigan, Michigan
| | - Patrick J Sparto
- Department of Physical Therapy, University of Pittsburgh, Pennsylvania.,Department of Otolaryngology.,Department of Bioengineering, University of Pittsburgh, Pennsylvania
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Luth C, Bartell D, Bish M, Yudd A, Palaima M, Cleland JA. The effectiveness of vestibular rehabilitation therapy vs conservative treatment on dizziness: a systematic review and meta-analysis. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2019.1670395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Carl Luth
- Department of Physical Therapy, Franklin Pierce University, Manchester, NH, USA
| | - Desiree Bartell
- Department of Physical Therapy, Franklin Pierce University, Manchester, NH, USA
| | - Michaela Bish
- Department of Physical Therapy, Franklin Pierce University, Manchester, NH, USA
| | - Andrew Yudd
- Department of Physical Therapy, Franklin Pierce University, Manchester, NH, USA
| | - Mary Palaima
- Department of Physical Therapy, Franklin Pierce University, Manchester, NH, USA
| | - Joshua A. Cleland
- Department of Physical Therapy, Franklin Pierce University, Manchester, NH, USA
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Abstract
Falls pose substantial challenges to health care institutions. This review aims to provide a synthesis and critique of studies that investigated fall injury risk factors and to identify significant risk factors that predispose patients to injurious falls. A comprehensive literature search was conducted in PubMed, COCHRANE, Embase, Cumulative Index to Nursing and Allied Heath Literature, and Scopus. Additional records were searched through Google Scholar and bibliographies of the retrieved articles. Twenty-three primary research studies were included. Demographic, intrinsic, and extrinsic factors have been identified. Demographics include age, gender, and marital status. Intrinsic factors include body mass index, medication, and preexisting conditions, and extrinsic factors include environmental factors. Several factors were found to be inconclusive. These factors should be considered and examined further. Future research may evaluate interventions focusing on targeted risk factors of injurious falls. Clinical guidelines addressing the factors in this review may be considered after further testing and research.
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30
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Menant JC, Migliaccio AA, Sturnieks DL, Hicks C, Lo J, Ratanapongleka M, Turner J, Delbaere K, Titov N, Meinrath D, McVeigh C, Close JCT, Lord SR. Reducing the burden of dizziness in middle-aged and older people: A multifactorial, tailored, single-blind randomized controlled trial. PLoS Med 2018; 15:e1002620. [PMID: 30040818 PMCID: PMC6057644 DOI: 10.1371/journal.pmed.1002620] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 06/21/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Dizziness is common among older people and is associated with a cascade of debilitating symptoms, such as reduced quality of life, depression, and falls. The multifactorial aetiology of dizziness is a major barrier to establishing a clear diagnosis and offering effective therapeutic interventions. Only a few multidisciplinary interventions of dizziness have been conducted to date, all of a pilot nature and none tailoring the intervention to the specific causes of dizziness. Here, we aimed to test the hypothesis that a multidisciplinary dizziness assessment followed by a tailored multifaceted intervention would reduce dizziness handicap and self-reported dizziness as well as enhance balance and gait in people aged 50 years and over with dizziness symptoms. METHODS AND FINDINGS We conducted a 6-month, single-blind, parallel-group randomized controlled trial in community-living people aged 50 years and over who reported dizziness in the past year. We excluded individuals currently receiving treatment for their dizziness, those with degenerative neurological conditions including cognitive impairment, those unable to walk 20 meters, and those identified at baseline assessment with conditions that required urgent treatment. Our team of geriatrician, vestibular neuroscientist, psychologist, exercise physiologist, study coordinator, and baseline assessor held case conferences fortnightly to discuss and recommend appropriate therapy (or therapies) for each participant, based on their multidisciplinary baseline assessments. A total of 305 men and women aged 50 to 92 years (mean [SD] age: 67.8 [8.3] years; 62% women) were randomly assigned to either usual care (control; n = 151) or to a tailored, multifaceted intervention (n = 154) comprising one or more of the following: a physiotherapist-led vestibular rehabilitation programme (35% [n = 54]), an 8-week internet-based cognitive-behavioural therapy (CBT) (19% [n = 29]), a 6-month Otago home-based exercise programme (24% [n = 37]), and/or medical management (40% [n = 62]). We were unable to identify a cause of dizziness in 71 participants (23% of total sample). Primary outcome measures comprised dizziness burden measured with the Dizziness Handicap Inventory (DHI) score, frequency of dizziness episodes recorded with monthly calendars over the 6-month follow-up, choice-stepping reaction time (CSRT), and gait variability. Data from 274 participants (90%; 137 per group) were included in the intention-to-treat analysis. At trial completion, the DHI scores in the intervention group (pre and post mean [SD]: 25.9 [19.2] and 20.4 [17.7], respectively) were significantly reduced compared with the control group (pre and post mean [SD]: 23.0 [15.8] and 21.8 [16.4]), when controlling for baseline scores (mean [95% CI] difference between groups [baseline adjusted]: -3.7 [-6.2 to -1.2]; p = 0.003). There were no significant between-group differences in dizziness episodes (relative risk [RR] [95% CI]: 0.87 [0.65 to 1.17]; p = 0.360), CSRT performance (mean [95% CI] difference between groups [baseline adjusted]: -15 [-40 to 10]; p = 0.246), and step-time variability during gait (mean [95% CI] difference between groups [baseline adjusted]: -0.001 [-0.002 to 0.001]; p = 0.497). No serious intervention-related adverse events occurred. Study limitations included the low initial dizziness severity of the participants and the only fair uptake of the falls clinic (medical management) and the CBT interventions. CONCLUSIONS A multifactorial tailored approach for treating dizziness was effective in reducing dizziness handicap in community-living people aged 50 years and older. No difference was seen on the other primary outcomes. Our findings therefore support the implementation of individualized, multifaceted evidence-based therapies to reduce self-perceived disability associated with dizziness in middle-aged and older people. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12612000379819.
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Affiliation(s)
- Jasmine C. Menant
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Americo A. Migliaccio
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - Daina L. Sturnieks
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Cameron Hicks
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Joanne Lo
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | | | - Jessica Turner
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Kim Delbaere
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Nickolai Titov
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Daniela Meinrath
- Department of Physiotherapy, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Catherine McVeigh
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Jacqueline C. T. Close
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen R. Lord
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
- * E-mail:
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Erlandson KM, Plankey MW, Springer G, Cohen HS, Cox C, Hoffman HJ, Yin MT, Brown TT. Fall frequency and associated factors among men and women with or at risk for HIV infection. HIV Med 2017; 17:740-748. [PMID: 27028463 DOI: 10.1111/hiv.12378] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Falls and fall-related injuries are a major public health concern. HIV-infected adults have been shown to have a high incidence of falls. Identification of major risk factors for falls that are unique to HIV infection or similar to those in the general population will inform development of future interventions for fall prevention. METHODS HIV-infected and uninfected men and women participating in the Hearing and Balance Substudy of the Multicenter AIDS Cohort Study and Women's Interagency HIV Study were asked about balance symptoms and falls during the prior 12 months. Falls were categorized as 0, 1, or ≥ 2; proportional odds logistic regression models were used to investigate relationships between falls and demographic and clinical variables and multivariable models were created. RESULTS Twenty-four per cent of 303 HIV-infected participants reported at least one fall compared with 18% of 233 HIV-uninfected participants (P = 0.27). HIV-infected participants were demographically different from HIV-uninfected participants, and were more likely to report clinical imbalance symptoms (P ≤ 0.035). In univariate analyses, more falls were associated with hepatitis C, female sex, obesity, smoking, and clinical imbalance symptoms, but not age, HIV serostatus or other comorbidities. In multivariable analyses, female sex and imbalance symptoms were independently associated with more falls. Among HIV-infected participants, smoking, a higher number of medications, and imbalance symptoms remained independent fall predictors, while current protease inhibitor use was protective. CONCLUSIONS Similar rates of falls among HIV-infected and uninfected participants were largely explained by a high prevalence of imbalance symptoms. Routine assessment of falls and dizziness/imbalance symptoms should be considered, with interventions targeted at reducing symptomatology.
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Affiliation(s)
- K M Erlandson
- Department of Medicine, Divisions of Infectious Diseases and Geriatric Medicine, University of Colorado, Aurora, CO, USA.
| | - M W Plankey
- Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA
| | - G Springer
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - H S Cohen
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - C Cox
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - H J Hoffman
- Epidemiology and Statistics Program, National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health (NIH), Bethesda, MD, USA
| | - M T Yin
- Department of Medicine, Division of Infectious Diseases, Columbia University Medical Center, New York, NY, USA
| | - T T Brown
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University, Baltimore, MD, USA
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Bhatt JM, Lin HW, Bhattacharyya N. Prevalence, Severity, Exposures, and Treatment Patterns of Tinnitus in the United States. JAMA Otolaryngol Head Neck Surg 2017; 142:959-965. [PMID: 27441392 DOI: 10.1001/jamaoto.2016.1700] [Citation(s) in RCA: 264] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Importance Tinnitus is a common problem for millions of individuals and can cause substantial negative effects on their quality of life. A large epidemiologic study of tinnitus and its management patterns in the US adult population is lacking. Objectives To quantify the epidemiologic features and effect of tinnitus and to analyze the management of tinnitus in the United States relative to the 2014 American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) clinical practice guidelines. Design, Methods, and Participants This cross-sectional analysis of the representative 2007 National Health Interview Survey (raw data, 75 764 respondents) identified a weighted national sample of adults (age, ≥18 years) who reported tinnitus in the preceding 12 months. Data were collected in November 2014 at the University of California, Irvine, and Harvard Medical School. Main Outcomes and Measures In addition to quantifying prevalence, severity, duration, and regularity of tinnitus, specific data regarding noise exposure and tinnitus management patterns during health care visits were analyzed. Results Among an estimated (SE) 222.1 (3.4) million US adults, 21.4 (3.4) million (9.6% [0.3%]) experienced tinnitus in the past 12 months. Among those who reported tinnitus, 27% had symptoms for longer than 15 years, and 36% had nearly constant symptoms. Higher rates of tinnitus were reported in those with consistent exposure to loud noises at work (odds ratio, 3.3; 95% CI, 2.9-3.7) and during recreational time (odds ratio, 2.6; 95% CI, 2.3-2.9). Years of work-related noise exposure correlated with increasing prevalence of tinnitus (r = 0.13; 95% CI, 0.10-0.16). In terms of subjective severity, 7.2% reported their tinnitus as a big or a very big problem compared with 41.6% who reported it as a small problem. Only 49.4% had discussed their tinnitus with a physician, and medications were the most frequently discussed recommendation (45.4%). Other interventions, such as hearing aids (9.2%), wearable (2.6%) and nonwearable (2.3%) masking devices, and cognitive behavioral therapy (0.2%), were less frequently discussed. Conclusions and Relevance The prevalence of tinnitus in the United States is approximately 1 in 10 adults. Durations of occupational and leisure time noise exposures correlated with rates of tinnitus and are likely targetable risk factors. Management options suggested by the recently published AAO-HNSF guidelines were followed infrequently.
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Affiliation(s)
- Jay M Bhatt
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine
| | - Harrison W Lin
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine
| | - Neil Bhattacharyya
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts
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Epidemiology of Dizzy Patient Population in a Neurotology Clinic and Predictors of Peripheral Etiology. Otol Neurotol 2017; 38:870-875. [DOI: 10.1097/mao.0000000000001429] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bhatt JM, Bhattacharyya N, Lin HW. Relationships between tinnitus and the prevalence of anxiety and depression. Laryngoscope 2017; 127:466-469. [PMID: 27301552 PMCID: PMC5812676 DOI: 10.1002/lary.26107] [Citation(s) in RCA: 214] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 04/27/2016] [Accepted: 05/01/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVES/HYPOTHESIS Quantify the relationships between tinnitus, and anxiety and depression among adults. STUDY DESIGN Cross-sectional analysis of a national health survey. METHODS Adult respondents in the 2007 Integrated Health Interview Series tinnitus module were analyzed. Data for tinnitus symptoms and severity and reported anxiety and depression symptoms were extracted. Associations between tinnitus problems and anxiety, depression, lost workdays, days of alcohol consumption, and mean hours of sleep were assessed. RESULTS Among 21.4 ± 0.69 million adult tinnitus sufferers, 26.1% reported problems with anxiety in the preceding 12 months, whereas only 9.2% of those without tinnitus reported an anxiety problem (P < .001). Similarly, 25.6% of respondents with tinnitus reported problems with depression, whereas only 9.1% of those without tinnitus reported depression symptoms (P < .001). Those reporting tinnitus symptoms as a "big" or "very big" problem were more likely to concurrently report anxiety (odds ratio [OR]: 5.7; 95% CI: 4.0-8.1; P < .001) and depression (OR: 4.8; 95% CI: 3.5-6.7; P < .001) symptoms. Tinnitus sufferers reported significantly fewer mean hours of sleep per night (7.00 vs. 7.21; P < .001) and greater mean days of work missed (6.94 vs. 3.79, P < .001) compared to those who did not report tinnitus. Mean days of alcohol consumption between the two groups were not significantly different. CONCLUSIONS Tinnitus symptoms are closely associated with anxiety, depression, shorter sleep duration, and greater workdays missed. These comorbidities and sequelae should be recognized and addressed to optimally manage patients with chronic and bothersome tinnitus. LEVEL OF EVIDENCE 4 Laryngoscope, 2016 127:466-469, 2017.
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Affiliation(s)
- Jay M Bhatt
- Department of Otolaryngology-Head & Neck Surgery, University of California, Irvine, Irvine, California
| | - Neil Bhattacharyya
- Department of Otology & Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Harrison W Lin
- Department of Otolaryngology-Head & Neck Surgery, University of California, Irvine, Irvine, California
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Kim SY, Bang W, Kim MS, Park B, Kim JH, Choi HG. Nocturia Is Associated with Slipping and Falling. PLoS One 2017; 12:e0169690. [PMID: 28060916 PMCID: PMC5218404 DOI: 10.1371/journal.pone.0169690] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 12/19/2016] [Indexed: 11/18/2022] Open
Abstract
Several reports have demonstrated associations between falls and nocturia in the elderly. However, little information is available regarding other age groups. This study evaluated the relationship between the frequency of nocturia and falls in men using a large, population-based survey in Korea, and the results were adjusted for various confounding factors. Data from a 2011 Korean community health survey (KCHS) were retrieved for 92,660 men aged 19 to 103 years. Information regarding the history of slips or falls in the past year was collected. The frequency of nocturia was classified as 0, 1, 2, 3, 4, and ≥ 5 instances a night. Walking during the day, education, income, body mass index (BMI), smoking, alcohol consumption, sleep time, stress level and medical histories of hypertension, diabetes mellitus, hyperlipidemia, cerebral stroke, angina or myocardial infarction, arthritis, and osteoporosis were adjusted using multiple logistic regression analysis with complex sampling. A subgroup analysis was conducted for young (19–30 years), middle-aged (31–60 years), and elderly individuals (61+ years). Approximately 14.6% of the men had a history of falls. Their mean age was 42.9 years, which was significantly higher than that of the non-faller group (P < 0.001). An increased frequency of nocturia was associated with increased adjusted odds ratio (AOR) for falls (AOR for 1 instance of nocturia/night = 1.41 [95% confidence interval, 1.33–1.50]; AOR for 2 instances = 1.41 [1.33–1.50]; AOR for 3 instances = 2.00 [1.75–2.28]; AOR for 4 instances = 2.12 [1.73–2.61]; AOR for ≥ 5 instances = 2.02 [1.74–2.36], P < 0.001). In the subgroup analysis, the AORs for falls significantly increased in all age groups as the frequency of nocturia increased.
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Affiliation(s)
- So Young Kim
- Department of Otorhinolaryngology-Head & Neck Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Woojin Bang
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Min-Su Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Bumjung Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Korea
| | - Jin-Hwan Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Korea
- * E-mail:
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Kammerlind ASC, Ernsth Bravell M, Fransson EI. Prevalence of and factors related to mild and substantial dizziness in community-dwelling older adults: a cross-sectional study. BMC Geriatr 2016; 16:159. [PMID: 27590725 PMCID: PMC5010717 DOI: 10.1186/s12877-016-0335-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 08/27/2016] [Indexed: 11/25/2022] Open
Abstract
Background Dizziness is highly prevalent among older people and associated with many health factors. The aim of the study was to determine the prevalence of and factors related to dizziness among community-dwelling older adults in Sweden. In contrast to previous studies, the subjects with dizziness were divided into two groups, mild and substantial dizziness, according to the frequency and intensity of dizziness. Methods A sample of 305 older persons between 75 and 90 years of age (mean age 81 years) were interviewed and examined. Subjects with dizziness answered the University of California Los Angeles Dizziness Questionnaire and questions about provoking movements. The groups with substantial, mild, or no dizziness were compared with regard to age, sex, diseases, drugs, blood pressure, physical activity, exercises, falls, fear of falling, quality of life, general health, mobility aids, and physical performance. Results In this sample, 79 subjects experienced substantial and 46 mild dizziness. Subjects with substantial dizziness were less physically active, reported more fear of falling, falls, depression/anxiety, diabetes, stroke/TIA, heart disease, a higher total number of drugs and antihypertensive drugs, lower quality of life and general health, and performed worse physically. Conclusions There are many and complex associations between dizziness and factors like falls, diseases, drugs, physical performance, and activity. For most of these factors, the associations are stronger in subjects with substantial dizziness compared with subjects with mild or no dizziness; therefore, it is relevant to differ between mild and substantial dizziness symptoms in research and clinical practice in the future.
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Affiliation(s)
- Ann-Sofi C Kammerlind
- Futurum, Region Jönköping County, SE-551 85, Jönköping, Sweden. .,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Marie Ernsth Bravell
- Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Eleonor I Fransson
- Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Impact of obesity in elderly patients with postural instability. Aging Clin Exp Res 2016; 28:423-8. [PMID: 26187012 DOI: 10.1007/s40520-015-0414-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 07/03/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of the study is to assess whether obesity affects balance in elderly patients with postural instability. STUDY DESIGN It is a case-control study, with cases defined by BMI ≥30 kg/m(2), and developed in a third level university hospital. METHODS We included 135 patients aged 65 years old or more who presented postural instability. Balance assessment was through the sensory organisation test (SOT), limits of stability (LOS) and rhythmic weight shift (RWS) of computerised dynamic posturography (CDP) and the modified timed up-and-go (TUG) test. The patients also completed the Dizziness Handicap Inventory and short Falls Efficacy Scale-International questionnaire. RESULTS Patients with obesity took longer to perform the modified TUG and required more steps. Also these patients had poorer scores in the subjective tests. In the CDP there were no significant differences in the SOT nor the LOS, and only there was a statistical significant difference in the anterior-posterior directional control of the RWS. Obese patients have a higher risk of fallings compared to non-obese patients. CONCLUSION In essence, our results indicate that obesity interferes in the balance of elderly patients with postural instability, putting them at a greater risk of fallings, performing worse dynamic tasks and feeling more disabled. Although continued education on training balance may be useful in older population, since the obese group shows more rate of fallers, rehabilitation programmes focus on dynamic tasks in these patients could be useful to reduce their fall risk and improve their quality of life.
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Bigelow RT, Semenov YR, du Lac S, Hoffman HJ, Agrawal Y. Vestibular vertigo and comorbid cognitive and psychiatric impairment: the 2008 National Health Interview Survey. J Neurol Neurosurg Psychiatry 2016; 87:367-72. [PMID: 25886779 DOI: 10.1136/jnnp-2015-310319] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/19/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS Patients with vestibular disease have been observed to have concomitant cognitive and psychiatric dysfunction. We evaluated the association between vestibular vertigo, cognitive impairment and psychiatric conditions in a nationally representative sample of US adults. METHODS We performed a cross-sectional analysis using the 2008 National Health Interview Survey (NHIS), which included a Balance and Dizziness Supplement, and questions about cognitive function and psychiatric comorbidity. We evaluated the association between vestibular vertigo, cognitive impairment (memory loss, difficulty concentrating, confusion) and psychiatric diagnoses (depression, anxiety and panic disorder). RESULTS We observed an 8.4% 1-year prevalence of vestibular vertigo among US adults. In adjusted analyses, individuals with vestibular vertigo had an eightfold increased odds of 'serious difficulty concentrating or remembering' (OR 8.3, 95% CI 4.8 to 14.6) and a fourfold increased odds of activity limitation due to difficulty remembering or confusion (OR 3.9, 95% CI 3.1 to 5.0) relative to the rest of the US adults. Individuals with vestibular vertigo also had a threefold increased odds of depression (OR 3.4, 95% CI 2.9 to 3.9), anxiety (OR 3.2, 95% CI 2.8 to 3.6) and panic disorder (OR 3.4, 95% CI 2.9 to 4.0). CONCLUSIONS Our findings indicate that vestibular impairment is associated with increased risk of cognitive and psychiatric comorbidity. The vestibular system is anatomically connected with widespread regions of the cerebral cortex, hippocampus and amygdala. Loss of vestibular inputs may lead to impairment of these cognitive and affective circuits. Further longitudinal research is required to determine if these associations are causal.
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Affiliation(s)
- Robin T Bigelow
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yevgeniy R Semenov
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sascha du Lac
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Howard J Hoffman
- Epidemiology and Statistics Program, Division of Scientific Programs, National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Yuri Agrawal
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Kim SY, Kim MS, Sim S, Park B, Choi HG. Association Between Obesity and Falls Among Korean Adults: A Population-Based Cross-Sectional Study. Medicine (Baltimore) 2016; 95:e3130. [PMID: 27015190 PMCID: PMC4998385 DOI: 10.1097/md.0000000000003130] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 02/15/2016] [Accepted: 02/25/2016] [Indexed: 02/03/2023] Open
Abstract
The objective of this study was to evaluate the association between falls and obesity using Asian body mass index (BMI) classifications. Using the data from the Korean community health survey in 2011, a total of 229,226 participants ranging from 19 to 106 years old were included in this study. The BMI groups were classified as underweight (<18.5), healthy (18.5 ≤ BMI < 23), overweight (23 ≤ BMI <25), and obese (≥25) using Asian BMI classifications. The associations between BMI groups and falls (≥1 time or ≥2 times per year) were analyzed using multiple logistic regression analyses with complex sampling. A subgroup analysis was conducted according to age (19-40, 41-60, and ≥61 years) and the location of the fall (indoor and outdoor). Physical activity, household income, education level, alcohol consumption, smoking, stress level, and medical comorbidities were adjusted as confounders. In total, 16.8% and 6.1% of the participants experienced falls ≥1 time and ≥2 times per year, respectively. Compared to the healthy weight group, the other BMI groups showed a significant U-shaped relationship with falls ≥1 time (AOR underweight = 1.12, 95% CI [confidence interval] = 1.05-1.19; AOR obese = 1.06, 95% CI = 1.02-1.10, P < 0.001) and ≥2 times (AOR underweight = 1.14, 95% CI = 1.04-1.26; AOR obese = 1.04, 95% CI = 0.99-1.10, P < 0.001). Obese status was significantly associated with falls (≥1 fall per year) in all age groups, whereas being underweight was significantly associated with falls in the 19 to 40 year age group only. In conclusion, both underweight and obese statuses were significantly associated with falls in this adult Korean population. However, the relationship between BMI group and falls varied according to age and the location of the falls.
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Affiliation(s)
- So Young Kim
- From the Department of Otorhinolaryngology-Head & Neck Surgery and Cancer Research Institute (SYK, M-SK), Seoul National University College of Medicine, Seoul, Korea; Department of Otorhinolaryngology-Head and Neck Surgery (SYK), CHA Bundang Medical Center, CHA University; Department of Otorhinolaryngology-Head and Neck Surgery (M-SK), Korea University Ansan Hospital, Korea University; Department of Statistics (SS), Hallym University, Chuncheon, Korea; and Department of Otorhinolaryngology-Head & Neck Surgery (BP, HGC), Hallym University Sacred Heart Hospital, Anyang, Korea
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Dizziness and death: An imbalance in mortality. Laryngoscope 2016; 126:2134-6. [DOI: 10.1002/lary.25902] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 01/04/2016] [Accepted: 01/07/2016] [Indexed: 11/07/2022]
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Abstract
This chapter gives an overview of the epidemiology of dizziness, vertigo, and imbalance, and of specific vestibular disorders. In the last decade, population-based epidemiologic studies have complemented previous publications from specialized settings and provided evidence for the high burden of dizziness and vertigo in the community. Dizziness (including vertigo) affects about 15% to over 20% of adults yearly in large population-based studies. Vestibular vertigo accounts for about a quarter of dizziness complaints and has a 12-month prevalence of 5% and an annual incidence of 1.4%. Its prevalence rises with age and is about two to three times higher in women than in men. Imbalance has been increasingly studied as a highly prevalent complaint particularly affecting healthy aging. Studies have documented the high prevalence of benign paroxysmal positional vertigo (BPPV) and vestibular migraine (VM), as well as of comorbid anxiety at the population level. BPPV and VM are largely underdiagnosed, while Menière's disease, which is about 10 times less frequent than BPPV, appears to be overdiagnosed. Risk factor research is only at its beginning, but has provided some interesting observations, such as the consistent association of vertigo and migraine, which has greatly contributed to the recognition of VM as a distinct vestibular syndrome.
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Affiliation(s)
- H K Neuhauser
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
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Dobie RA. In reference to Impact of dizziness and obesity of the prevalence of falls and fall-related injuries. Laryngoscope 2015; 125:E350. [PMID: 25677369 DOI: 10.1002/lary.25208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Robert A Dobie
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science enter at San Antonio, San Antonio, Texas
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